The app was informed by research examining people’s understanding of disability and the NDIS in remote communities and the need for tools that help them understand the supports available. Indigenous Australians experiencing disability at twice the rate of those who are non-Indigenous.
The Disability in the Bush app delivers plain language, culturally relevant information and video stories via mobile phones and other devices to bridge the knowledge gap about disability, and help Indigenous Australians connect with the NDIS.
The free app was created by and Ninti One and Interplay, and funded by the National Disability Insurance Agency, and includes translations in two central Indigenous languages – Arrernte and Pitjantjatjara – with plans for a further three Top End languages in the coming months.
The Disability in the Bush app was developed following research across five Indigenous communities which examined people’s understanding of disability and their awareness of the NDIS. The interviews found that official information is delivered using unfamiliar language and concepts, or via channels that communities don’t use.
Ninti One Aboriginal Community Researchers found that many community members knew of ‘the purple shirt mob’– a reference to the purple shirts worn by NDIS staff – but few people knew what supports were available, and in some cases didn’t know they were eligible.
“Aboriginal Australians are twice as likely to have a disability as non-Aboriginal Australians, but too many don’t understand the NDIS. We need to shape the system around the end users, not the other way around,” said Professor Sheree Cairney, Director of Interplay.
“By bringing government, science and community together in a shared space, we have created a tool to get vital information to people in remote communities. This app combines knowledge translation principles and technology and is designed by, and for, Aboriginal people,” said Tammy Abbott, Community Engagement Officer and Indigenous lead for the project.
Indigenous people led the development of the app from the research stage, identifying challenges for people trying to access the NDIS, right through to the language used on the site and the look and feel.
“People in remote Indigenous communities have particular information needs due to their culture, environment and isolation, and for people with disability these needs are even more specific,” said Rod Reeve, Managing Director of Ninti One
“The Disability in the Bush app brings together culturally relevant ideas, video stories of more than 20 Aboriginal people and translations to create a one-stop-shop for Aboriginal people, their carers and family, and support workers,” he said.
This new plain language publication provides information for a wider (non-academic) audience and incorporates many visual elements.
The Summary is useful for health workers and those studying in the field as a quick source of general information. It provides key information regarding the health status of Aboriginal and Torres Strait Islander people across the following topics:
The Summary is available online and in hardcopy format. Please contact HealthInfoNet by email if you wish to order a hardcopy of this Summary. Other reviews and plain language summaries are available here.
Here are the key facts
Please note in an earlier version sent out 7.00 am June 15 a computer error dropped off the last word in many sentences : these are new fixed
In 2019, the estimated Australian Aboriginal and Torres Strait Islander population was 847,190.
In 2019, NSW had the highest number of Aboriginal and Torres Strait Islander people (the estimated population was 281,107 people, 33% of the total Aboriginal and Torres Strait Islander population).
In 2019, NT had the highest proportion of Aboriginal and Torres Strait Islander people in its population, with 32% of the NT population identifying as Aboriginal and/or Torres Strait Islanders
In 2016, around 37% of Aboriginal and Torres Strait Islander people lived in major cities
The Aboriginal and Torres Strait Islander population is much younger than the non-Indigenous population.
Births and pregnancy outcomes
In 2018, there were 21,928 births registered in Australia with one or both parents identified as Aboriginal and/or Torres Strait Islander (7% of all births registered).
In 2018, the median age for Aboriginal and Torres Strait Islander mothers was 26.0 years.
In 2018, total fertility rates were 2,371 births per 1,000 for Aboriginal and Torres Strait Islander women.
In 2017, the average birthweight of babies born to Aboriginal and Torres Strait Islander mothers was 3,202 grams
The proportion of low birthweight babies born to Aboriginal and Torres Strait Islander mothers between 2007 and 2017 remained steady at around 13%.
For 2018, the age-standardised death rate for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT was 1 per 1,000.
Between 1998 and 2015, there was a 15% reduction in the death rates for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT.
For Aboriginal and Torres Strait Islander people born 2015-2017, life expectancy was estimated to be 6 years for males and 75.6 years for females, around 8-9 years less than the estimates for non-Indigenous males and females.
In 2018, the median age at death for Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT was 2 years; this was an increase from 55.8 years in 2008.
Between 1998 and 2015, the Aboriginal and Torres Strait Islander infant mortality rate has more than halved (from 5 to 6.3 per 1,000).
In 2018, the leading causes of death among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT were ischaemic heart disease (IHD), diabetes, chronic lower respiratory diseases and lung and related cancers.
For 2012-2017 the maternal mortality ratio for Aboriginal and Torres Strait Islander women was 27 deaths per 100,000 women who gave birth.
For 1998-2015, in NSW, Qld, WA, SA and the NT there was a 32% decline in the death rate from avoidable causes for Aboriginal and Torres Strait Islander people aged 0-74 years
In 2017-18, 9% of all hospital separations were for Aboriginal and Torres Strait Islander people.
In 2017-18, the age-adjusted separation rate for Aboriginal and Torres Strait Islander people was 2.6 times higher than for non-Indigenous people.
In 2017-18, the main cause of hospitalisation for Aboriginal and Torres Strait Islander people was for ‘factors influencing health status and contact with health services’ (mostly for care involving dialysis), responsible for 49% of all Aboriginal and Torres Strait Islander seperations.
In 2017-18, the age-standardised rate of overall potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people was 80 per 1,000 (38 per 1,000 for chronic conditions and 13 per 1,000 for vaccine-preventable conditions).
Selected health conditions
In 2018-19, around 15% of Aboriginal and Torres Strait Islander people reported having cardiovascular disease (CVD).
In 2018-19, nearly one quarter (23%) of Aboriginal and Torres Strait Islander adults were found to have high blood pressure.
For 2013-2017, in Qld, WA, SA and the NT combined, there were 1,043 new rheumatic heart disease diagnoses among Aboriginal and Torres Strait Islander people, a crude rate of 50 per 100,000.
In 2017-18, there 14,945 hospital separations for CVD among Aboriginal and Torres Strait Islander people, representing 5.4% of all Aboriginal and Torres Strait Islander hospital separations (excluding dialysis).
In 2018, ischaemic heart disease (IHD) was the leading specific cause of death of Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT
In 2018-19, 1% of Aboriginal and Torres Strait Islander people reported having cancer (males 1.2%, females 1.1%).
For 2010-2014, the most common cancers diagnosed among Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA and the NT were lung cancer and breast (females) cancer.
Survival rates indicate that of the Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA, and the NT who were diagnosed with cancer between 2007 and 2014, 50% had a chance of surviving five years after diagnosis
In 2016-17, there 8,447 hospital separations for neoplasms2 among Aboriginal and Torres Strait Islander people
For 2013-2017, the age-standardised mortality rate due to cancer of any type was 238 per 100,000, an increase of 5% when compared with a rate of 227 per 100,000 in 2010-2014.
In 2018-19, 8% of Aboriginal people and 7.9% of Torres Strait Islander people reported having diabetes.
In 2015-16, there were around 2,300 hospitalisations with a principal diagnosis of type 2 diabetes among Aboriginal and Torres Strait Islander people
In 2018, diabetes was the second leading cause of death for Aboriginal and Torres Strait Islander people.
The death rate for diabetes decreased by 0% between 2009-2013 and 2014-2018.
Some data sources use term ‘neoplasm’ to describe conditions associated with abnormal growth of new tissue, commonly referred to as a Neoplasms can be benign (not cancerous) or malignant (cancerous) .
Social and emotional wellbeing
In 2018-19, 31% of Aboriginal and 23% of Torres Strait Islander respondents aged 18 years and over reported high or very high levels of psychological distress
In 2014-15, 68% of Aboriginal and Torres Strait Islander people aged 15 years and over and 67% of children aged 4-14 years experienced at least one significant stressor in the previous 12 months
In 2012-13, 91% of Aboriginal and Torres Strait Islander people reported on feelings of calmness and peacefulness, happiness, fullness of life and energy either some, most, or all of the time.
In 2014-15, more than half of Aboriginal and Torres Strait Islander people aged 15 years and over reported an overall life satisfaction rating of at least 8 out of 10.
In 2018-19, 25% of Aboriginal and 17% of Torres Strait Islander people, aged two years and over, reported having a mental and/or behavioural conditions
In 2018-19, anxiety was the most common mental or behavioural condition reported (17%), followed by depression (13%).
In 2017-18, there were 21,940 hospital separations with a principal diagnosis of International Classification of Diseases (ICD) ‘mental and behavioural disorders’ identified as Aboriginal and/or Torres Strait Islander
In 2018, 169 (129 males and 40 females) Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA, and the NT died from intentional self-harm (suicide).
Between 2009-2013 and 2014-2018, the NT was the only jurisdiction to record a decrease in intentional self-harm (suicide) death rates.
In 2018-19, 8% of Aboriginal and Torres Strait Islander people (Aboriginal people 1.9%; Torres Strait Islander people 0.4%) reported kidney disease as a long-term health condition.
For 2014-2018, after age-adjustment, the notification rate of end-stage renal disease was 3 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
In 2017-18, ‘care involving dialysis’ was the most common reason for hospitalisation among Aboriginal and Torres Strait Islander people.
In 2018, 310 Aboriginal and Torres Strait Islander people commenced dialysis and 49 were the recipients of new kidneys.
For 2013-2017, the age-adjusted death rate from kidney disease was 21 per 100,000 (NT: 47 per 100,000; WA: 38 per 100,000) for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and NT
In 2018, the most common causes of death among the 217 Aboriginal and Torres Strait Islander people who were receiving dialysis was CVD (64 deaths) and withdrawal from treatment (51 deaths).
Injury, including family violence
In 2012-13, 5% of Aboriginal and Torres Strait Islander people reported having a long-term condition caused by injury.
In 2018-19, 16% of Aboriginal and Torres Strait Islander people aged 15 years and over had experienced physical harm or threatened physical harm at least once in the last 12 months.
In 2016-17, the rate of Aboriginal and Torres Strait Islander hospitalised injury was higher for males (44 per 1,000) than females (39 per 1,000).
In 2017-18, 20% of injury-related hospitalisations among Aboriginal and Torres Strait Islander people were for assault.
In 2018, intentional self-harm was the leading specific cause of injury deaths for NSW, Qld, SA, WA, and NT (5.3% of all Aboriginal and Torres Strait Islander deaths).
In 2018-19, 29% of Aboriginal and Torres Strait Islander people reported having a long-term respiratory condition .
In 2018-19, 16% of Aboriginal and Torres Strait Islander people reported having asthma.
In 2014-15, crude hospitalisation rates were highest for Aboriginal and Torres Strait Islander people presenting with influenza and pneumonia (7.4 per 1,000), followed by COPD (5.3 per 1,000), acute upper respiratory infections (3.8 per 1,000) and asthma (2.9 per 1,000).
In 2018, chronic lower respiratory disease was the third highest cause of death overall for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT
In 2018-19, eye and sight problems were reported by 38% of Aboriginal people and 40% of Torres Strait Islander people.
In 2018-19, eye and sight problems were reported by 32% of Aboriginal and Torres Strait Islander males and by 43% of females.
In 2018-19, the most common eye conditions reported by Aboriginal and Torres Strait Islanders were hyperopia (long sightedness: 22%), myopia (short sightedness: 16%), other diseases of the eye and adnexa (8.7%), cataract (1.4%), blindness (0.9%) and glaucoma (0.5%).
In 2014-15, 13% of Aboriginal and Torres Strait Islander children, aged 4-14 years, were reported to have eye or sight problems.
In 2018, 144 cases of trachoma were detected among Aboriginal and Torres Strait Islander children living in at-risk communities in Qld, WA, SA and the NT
For 2015-17, 62% of hospitalisations for diseases of the eye (8,274) among Aboriginal and Torres Strait Islander people were for disorders of the lens (5,092) (mainly cataracts).
Ear health and hearing
In 2018-19, 14% of Aboriginal and Torres Strait Islander people reported having a long-term ear and/or hearing problem
In 2018-19, among Aboriginal and Torres Strait Islander children aged 0-14 years, the prevalence of otitis media (OM) was 6% and of partial or complete deafness was 3.8%.
In 2017-18, the age-adjusted hospitalisation rate for ear conditions for Aboriginal and Torres Strait Islander people was 1 per 1,000 population.
In 2014-15, the proportion of Aboriginal and Torres Strait Islander children aged 4-14 years with reported tooth or gum problems was 34%, a decrease from 39% in 2008.
In 2012-2014, 61% of Aboriginal and Torres Strait Islander children aged 5-10 years had experienced tooth decay in their baby teeth, and 36% of Aboriginal and Torres Strait Islander children aged 6-14 years had experienced tooth decay in their permanent teeth.
In 2016-17, there were 3,418 potentially preventable hospitalisations for dental conditions for Aboriginal and Torres Strait Islander The age-standardised rate of hospitalisation was 4.6 per 1,000.
In 2018-19, 27% of Aboriginal and 24% of Torres Strait Islander people reported having a disability or restrictive long-term health
In 2018-19, 2% of Aboriginal and 8.3% of Torres Strait Islander people reported a profound or severe core activity limitation.
In 2016, 7% of Aboriginal and Torres Strait Islander people with a profound or severe disability reported a need for assistance.
In 2017-18, 9% of disability service users were Aboriginal and Torres Strait Islander people, with most aged under 50 years (82%).
In 2017-18, the primary disability groups accessing services were Aboriginal and Torres Strait Islander people with a psychiatric condition (24%), intellectual disability (23%) and physical disability (20%).
In 2017-18, 2,524 Aboriginal and Torres Strait Islander National Disability Agreement service users transitioned to the National Disability Insurance Scheme.
In 2017, there were 7,015 notifications for chlamydia for Aboriginal and Torres Strait Islander people, accounting for 7% of the notifications in Australia
During 2013-2017, there was a 9% and 9.8% decline in chlamydia notification rates among males and females (respectively).
In 2017, there were 4,119 gonorrhoea notifications for Aboriginal and Torres Strait Islander people, accounting for 15% of the notifications in Australia.
In 2017, there were 779 syphilis notifications for Aboriginal and Torres Strait Islander people accounting for 18% of the notifications in Australia.
In 2017, Qld (45%) and the NT (35%) accounted for 80% of the syphilis notifications from all jurisdictions.
In 2018, there were 34 cases of newly diagnosed human immunodeficiency virus (HIV) infection among Aboriginal and Torres Strait Islander people in Australia .
In 2017, there were 1,201 Aboriginal and Torres Strait Islander people diagnosed with hepatitis C (HCV) in Australia
In 2017, there were 151 Aboriginal and Torres Strait Islander people diagnosed with hepatitis B (HBV) in Australia
For 2013-2017 there was a 37% decline in the HBV notification rates for Aboriginal and Torres Strait Islander people.
For 2011-2015, 1,152 (14%) of the 8,316 cases of invasive pneumococcal disease (IPD) were identified as Aboriginal and Torres Strait people .
For 2011-2015, there were 26 deaths attributed to IPD with 11 of the 26 deaths (42%) in the 50 years and over age-group.
For 2011-2015, 101 (10%) of the 966 notified cases of meningococcal disease were identified as Aboriginal and Torres Strait Islander people
For 2006-2015, the incidence rate of meningococcal serogroup B was 8 per 100,000, with the age- specific rate highest in infants less than 12 months of age (33 per 100,000).
In 2015, of the 1,255 notifications of TB in Australia, 27 (2.2%) were identified as Aboriginal and seven (0.6%) as Torres Strait Islander people
For 2011-2015, there were 16 Aboriginal and Torres Strait Islander people diagnosed with invasive Haemophilus influenzae type b (Hib) in Australia
Between 2007-2010 and 2011-2015 notification rates for Hib decreased by around 67%.
In 2018-19, the proportion of Aboriginal and Torres Strait Islander people reporting a disease of the skin and subcutaneous tissue was 2% (males 2.4% and females 4.0%).
“First Peoples with disability, who are already experiencing higher levels of disadvantage and are extremely vulnerable to COVID-19, are at risk of being triaged out of the health system or being provided with inadequate support.
A lot of Indigenous people with disabilities face race discrimination, disability discrimination or an intersection of both.
And unfortunately we have a situation where people are very reluctant to engage in the health system because they might have well-founded fears around how they might be treated “
With reports from countries such as America finding that marginalised people are missing out on emergency health care, Damian Griffis, CEO of the First Peoples Disability Network Australia (FPDN), told Pro Bono News he feared the same would happen to Aboriginal people
As talks of easing lockdown restrictions begin, experts fear Aboriginal Australians with disability will be overlooked and “triaged out of the health system”.
It has prompted FPDN , in partnership with Sydney Health Law and the Disability Innovation Institute UNSW, to release guidelines on providing ethical health care for Indigenous people with disability.
The points of action put First Peoples with a disability in a position where they can speak to decision-makers and help them provide appropriate responses to the pandemic.
The recommendations include recognising that disability care is a critical health service for Indigenous people and should be funded as such, including Indigenous people in decision-making processes regarding healthcare during the pandemic, helping restore trust in healthcare systems, and providing culturally appropriate services.
Griffis said that while Australian health services were dealing with the pandemic in a fair way, putting into place the recommendations would make sure it stayed that way.
“It looks as though we are on the right track, but nonetheless these principles should inform access to intensive care,” he said.
He also said that with such a big focus on healthcare at the moment, it was a good opportunity to review the entire healthcare experience for Indigenous people with disability, beyond the pandemic.
Discussions of easing restrictions, nation-wide, potentially present a higher risk of increasing numbers of outbreaks across the country.
These ethical considerations must be adapted and implemented.
1.All Federal, State and Territory government agencies must remove disability from consideration of resource allocation when it is used as a broad criterion for exclusion from critical care.
2.State and Federal health authorities must commit to including First Peoples with a disability in planning for decision-making regarding healthcare during the pandemic.
3.State and Federal health authorities must commit to identifying areas of strain and work to re-establish strong relationships of trust and confidence with the First Peoples affected. In cases where that cannot be implemented, arrangements should be made to give access to alternative healthcare resources.
4.State and Territory policies on pandemic healthcare must expressly refer to the need to be culturally competent when providing services to First Peoples with a disability.
5.The State and Territory governments must look at how more students can be transitioned into the Aboriginal and Torres Strait Islander Healthcare workforce.
6.State and Territory governments must understand this existential threat and take whatever action is necessary to protect Elders as the guardians of First Peoples’ cultures.
” The 2011 Census indicated that Aboriginal and Torres Strait Islander people experience profound or severe disability at higher rates than non-Indigenous Australians at all ages, with 6.1% of Indigenous males and 5.4% of Indigenous females reporting a profound or severe disability.1
The Australian Bureau of Statistics found in 2015 that Aboriginal and Torres Strait Islander people were 1.8 times more likely than non-Indigenous people to be living with a disability.2
The First People Disability Network (FPDN) estimates that the current number of Aboriginal and Torres Strait Islander people nationally eligible for participation in the NDIS is around 60,000.3 “
Representing a major change in the way supports for people living with disability are funded, the National Disability Insurance Scheme (NDIS) presents both opportunities and significant challenges.
This project, Understanding disability through the lens of Aboriginal and/or Torres Strait Islander people – challenges and opportunities, was developed to examine the:
Implementation of the NDIS Aboriginal and Torres Strait Islander Engagement Strategy1
Interaction between National Disability Insurance Agency (NDIA) staff, local area co-ordinators (LACs) and Aboriginal Community Controlled Health Services (ACCHSs) and non-governmental organisations (NGOs)
Experiences of Aboriginal and/or Torres Strait Islander people in accessing the NDIS, planning, and receiving disability supports through the scheme
The research was conducted in collaboration with the MJD Foundation (MJDF) and Synapse, organisations which have longstanding connections with Aboriginal and/or Torres Strait Islander communities in the Northern Territory and Queensland respectively
The National Disability Insurance Scheme (NDIS) represents a major change in the way the services and supports for people with disability are funded.
It presents both tremendous opportunity yet significant challenges.
Ensuring that Aboriginal and Torres Strait Islander people receive the same care as other Australians is an important human rights obligation. This project will improve the ability of the NDIS to achieve this.
At this stage, with the exception of an evaluation conducted in Barkly, very little is known about the roll-out of the NDIS to Aboriginal and Torres Strait Islander people.
This project will examine:
the implementation of the NDIS Aboriginal and Torres Strait Islander engagement strategy
the interaction between the National Disability Agency (NDIA) staff, local area co-ordinators and Aboriginal Community Controlled Health Services (ACCHSs) and NGOs
the experiences of Aboriginal and Torres Strait Islander people in accessing the NDIS program, planning and receiving the supports/services through the program.
Recognition that Aboriginal and Torres Strait Islander people with disabilities are not well served by mainstream services has led to strong advocacy and the development of culturally competent service models by the community controlled and NGO sector.
This project is a collaboration of 3 such organisations; Machado Joseph Disease Foundation (MJDF), Synapse and First Peoples Disability Network and the University of Melbourne.
The project will take a co-design approach to developing a study of the roll out of the NDIS for Aboriginal and Torres Strait Islander people.
Co-design, or experience-based co-design, is not only a way to actively involve consumers in the design, delivery and/or evaluation of services but also enables the design of systems where consumer and carer experiences are central.4
Our approach to the project will bring together expertise from Aboriginal and Torres Strait Islander organisations working to provide services to people with disabilities, with researchers and policy makers.
The approach to design and data collection will support Aboriginal and Torres Strait Islander leadership, optimise existing data and knowledge, and develop local research capacity among Aboriginal and Torres Strait Islander people.
It will bring together community, researchers, providers, policy makers and NDIA staff and develop an evidence informed approach to improving the NDIS and developing a workforce to support it.
The project will involve four phases:
Establishment of a project reference group
Reporting and review.
It is expected that the project will identify strengths and weaknesses of the NDIS implementation. It will identify promising strategies to improve the ways the NDIA works with Aboriginal and Torres Strait Islander people and organisations.
B. Nicholas, Y. Mandy & G. Matthew 2013, Paper 6: Disability, Centre for Aboriginal Economic Policy Research, Canberra
Australian Bureau of Statistics (ABS) 2017, 4430.0 – Disability, Ageing and Carers, Australia: Summary of Findings, 2015: Aboriginal and Torres Strait Islander people with disability, ABS, Canberra.
V. Aimee & G. Declan 2017, Concern over speed of NDIS rollout in Indigenous communities as NSW launches approach, ABC News, available at: https://www.abc.net.au/news/2017-04-20/concern-over-speed-of-ndis-rollout-in-indigenous-communities/8458076
“For Indigenous Australians living in regional and remote regions, it can be unfeasible to meet the medical evidence requirements as well as access treatments because of the lack of readily available specialists and medical services.
There are also really serious implications around their personal time and the resources that they have to invest in, in order to collate that evidence, travelling long distances to and from appointments to gain the medical evidence required which is not funded.”
Applicants also required significant support and assistance with advocating their eligibility for the DSP, understanding the paperwork and attending appointments.
In many cases, family members, non-medical service providers and medical practitioners stepped into an advocacy role. ”
“The lack of aged care and disability services in regional and remote areas is a major problem that needs to be addressed in ways that take account of the lack of economies of scale and difficulty in attracting health professionals to such areas, as well the need for culturally responsive service delivery. This requires consideration of regional hub models and opportunities for joint initiatives in workforce development, capacity building and the employment of specialist and other allied health professionals.
Some ACCHSs already provide aged care and disability services, sometimes by default due to the failure or lack of service providers. There is further potential for ACCHSs to employ staff who can provide aged care and disability services.
Our vision is for people with disabilities in remote and regional areas to be able to access the services they need and to lead active and fulfilling lives. And for our old people to be able to live out their days in dignity on country and pass away surrounded by family.
We have such a long way to go to achieve this vision and we hope that the current Royal Commissions into these areas will provide a catalyst for action.”
Two in five Indigenous households relying on the Disability Support Pension ran out of money for basic items such as food and fuel in the last year, new research shows, prompting calls from disability advocates for the government to urgently review the scheme.
The research is one of three new studies highlighting the economic and health impacts of disability, particularly for Aboriginal and Torres Strait Islanders, officially launched on Tuesday by the Australian Federation of Disability Organisations (AFDO).
The research found Aborginal and Torres Strait Islanders were two and a half times more likely to be on the Disability Support Pension than their non-Indigenous counterparts because of greater exposure to disadvantage, and were more likely to face barriers when accessing support.
Associate Professor Karen Soldactic, a lead author of a report examining the challenges of Indigenous people accessing the DSP, said the extensive evidence required to prove a person had a permanent disability was often a difficult and expensive exercise.
People with disability were found to spend $107 a week more on basic living costs such as transport and healthcare than people without disability and due to successive governments cracking down on the eligibility criteria of the scheme, many who may have been eligible in the past no longer had access to the DSP.
The pool of disability pensioners shrunk from 824,470 in 2014 to 750,045 in 2018.
In 2010-11, 69 per cent of claims were successful. Now, only 29.8 per cent of applicants are approved.
More than 200,000 people with disability were now receiving the lower Newstart Allowance (NSA) and tens of thousands of people were not receiving any support at all.
The report found over 13 per cent of Indigenous DSP recipients could not afford meals, 23 per cent sought financial help from welfare groups, and 34 per cent went to family and friends for money.
AFDO CEO, Ross Joyce said the financial cost of living with disability and the declining access to the DSP was causing significant economic, social, psychological stress and unnecessary hardship for people with disability.
“There are a lot of additional costs of living with disability, including accessible housing, transport and access to health services. These costs are particularly acute for people with disability living in regional and remote areas of Australia,” Joyce said.
AFDO and the report authors said the government needed to immediately review the adequacy of the DSP to ensure the eligibility process didn’t cause further financial hardship, and was fair for all participants.
Joyce said the barriers put in place by both Labor and Coalition governments for people accessing the DSP over the past two decades needed to be wound back.
“Those changes haven’t resulted in more people with disability working,” he said.
“Instead they’ve resigned more people with disability to poverty and financial insecurity and caused stress and heartache.”
Have your say about what is needed to make real change in the lives of Aboriginal and Torres Strait Islander people#HaveYourSayabout#closingthegap
There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.
The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.
5 – 7 November NACCHO Conference and AGM -Darwin NT
Download the 2019 Health Awareness Days Calendar
21 May First Peoples Disability Network, Is hosting a Human Rights Literacy forum
24 May National Sorry Day Bridge Walk Canberra
24-26 May AMA NATIONAL CONFERENCE – #amanatcon
25 May The Long Walk Melbourne
27 May to 5 June National Reconciliation Week #NRW2019
18 -20 June Lowitja Health Conference Darwin
2019 Dr Tracey Westerman’s Workshops
5 July NAIDOC week Symposium
6 July National NAIDOC Awards Canberra
7 -14 July 2019 National NAIDOC Grant funding round opens
2-5 August Garma Festival
29th – 30th August 2019 NACCHO OCHRE DAY
23 -25 September IAHA Conference Darwin
24 -26 September 2019 CATSINaM National Professional Development Conference
9-10 October2019 NATSIHWA 10 Year Anniversary Conference
16 October Melbourne Uni: Aboriginal and Torres Strait Islander Health and Wellbeing Conference
4 November NACCHO Youth Conference -Darwin NT
5 – 7 November NACCHO Conference and AGM -Darwin NT
5-8 November The Lime Network Conference New Zealand
Featured Save a dates date
20-26 May 2019 Family Matters Week of Action
” SNAICC congratulates the returning Coalition Government, and is ready to work alongside a new Indigenous Affairs Minister and Social Services Minister to prioritise better outcomes for Aboriginal and Torres Strait Islander children.
We believe that this most urgently requires a national strategy, with generational targets, to eliminate over-representation of our children in out-of home care and address the causes of child removal, as well as ensure all Aboriginal and Torres Strait Islander children have adequate access to quality education in the early years of their lives.
The complexity and depth of the issue – spanning both federal and state government powers – requires a holistic national strategy if we are to make any real dents. The incoming Federal Government has a responsibility to demonstrate commitment and leadership by starting this process, premised on the principles of self-determination and partnership agreed under the Closing the Gap refresh process.”
“ We need to see better commitment from our federal leaders to break the cycle of trauma for our children and families, and support evidence-based, community-led solutions.
So many Aboriginal children aren’t able to access early years education, which is such a crucial time in their education journey. It’s clearly an area that Australia should and must be doing better.
There are over 17,000 Aboriginal and Torres Strait Islander children in out-ofhome care at this very minute, having been removed from their families; there’s no denying that’s a national crisis. Through the Closing the Gap refresh, the government has shown a clear desire to work with communities to address this crisis, and we’re hopeful that a strong relationship with a new minister can produce some real change for our children and families.”
Throughout the National Week of Action, from 20-26 May, child welfare organisations and individual supporters from across the country are encouraged to play their part in raising awareness about the escalating number of Aboriginal and Torres Strait Islander children being removed from family.
“Family Matters seeks to foster an environment where there is wellbeing, safety and stability for all children. For Aboriginal children this means fostering a greater sense of belonging by growing up in family and community, and in a society that respects and values who they are as Aboriginal people.”
Muriel Bamblett, SNAICC Chairperson
During this week, we highlight the fundamental issues that affect Aboriginal and Torres Strait Islander children. Most importantly, we’re working to shine a light on the disconnection of Aboriginal and Torres Strait Islander children from community, culture and country.
inform service providers, policy decision makers, and the Australian public of the national crisis in Aboriginal and Torres Strait Islander over-representation in out-of home care
garner support to ensure that all Aboriginal and Torres Strait Islander children and young people grow up safe and cared for within family, community and culture
ensure that Aboriginal and Torres Strait Islander families, communities and organisations are empowered to exercise their responsibilities for the safety and wellbeing of their children
Find out more about what you can do and use our resources below to take action
What you can do
As a Family Matters supporter, we are calling on your organisation to further support Family Matters by hosting an event and promoting the National Week of Action via your organisation’s website, social media and other communications channels.
Hold an event in your workplace, engage your supporters, members and staff in discussions about the escalating number of Aboriginal and Torres Strait Islander children being removed from their family, and the power you have to influence change.
And copy and paste the following messaging to use on platforms such as Facebook, Twitter and LinkedIn.
Check back soon for a Facebook frame so you can change your profile to show your support for the campaign.
On Twitter, use the hashtag #BecauseOfThemWeMust
[I / We / your organisation] believe/s that #FamilyMatters. Aboriginal and Torres Strait Islander children are 11x more likely to be removed from their families than other Australian children. Our children deserve better. #BecauseOfThemWeMust
All welcome, Catering will be provided.
Location: Aboriginal Advancement League
THORNBURY, Tuesday 21 May 2019
24 May National Sorry Day Bridge Walk Canberra
24-26 May AMA NATIONAL CONFERENCE – #amanatcon
The 2019 AMA National Conference at Sofitel Brisbane, from 24-26 May, will feature an impressive line-up of influential health leaders, speakers and panellists, prestigious awards, and international speakers.
International speakers include Dr Barbara McAneny, the President of the American Medical Association, and Dr Michael Myers, a specialist in doctors’ health and the author or co-author of 150 scientific publications and eight books, including Why Physicians Die By Suicide: Lessons Learned from Their Families and Others Who Cared.
Policy sessions include: Doctors’ Health – Protecting Doctors and Their Families: A Call to Action; Aged Care – Improving Clinical Care in an Era of Financial Constraint; Artificial Intelligence in Health Care; and Reforming Australia’s Mental Health System.
Delegates will also debate key contemporary health issues from the floor of the Conference.
27 May to 5 June National Reconciliation Week #NRW2019
At the heart of reconciliation is the relationship between the broader Australian community and Aboriginal and Torres Strait Islander peoples. To foster positive race relations, our relationship must be grounded in a foundation of truth.
Aboriginal and Torres Strait Islander peoples have long called for a comprehensive process of truth-telling about Australia’s colonial history. Our nation’s past is reflected in the present, and will continue to play out in future unless we heal historical wounds.
Today, 80 per cent of Australians believe it is important to undertake formal truth telling processes, according to the 2018 Australian Reconciliation Barometer. Australians are ready to come to terms with our history as a crucial step towards a unified future, in which we understand, value and respect each other.
Whether you’re engaging in challenging conversations or unlearning and relearning what you know, this journey requires all of us to walk together with courage. This National Reconciliation Week, we invite Australians from all backgrounds to contribute to our national movement towards a unified future.
What is National Reconciliation Week?
National Reconciliation Week (NRW) is a time for all Australians to learn about our shared histories, cultures, and achievements, and to explore how each of us can contribute to achieving reconciliation in Australia.
The dates for NRW remain the same each year; 27 May to 3 June. These dates commemorate two significant milestones in the reconciliation journey— the successful 1967 referendum, and the High Court Mabo decision respectively.
Reconciliation must live in the hearts, minds and actions of all Australians as we move forward, creating a nation strengthened by respectful relationships between the wider Australian community, and Aboriginal and Torres Strait Islander peoples.
At the Lowitja Institute International Indigenous Health and Wellbeing Conference 2019 delegates from around the world will discuss the role of First Nations in leading change and will showcase Indigenous solutions.
The conference program will highlight ways of thinking, speaking and being for the benefit of Indigenous peoples everywhere.
Join Indigenous leaders, researchers, health professionals, decision makers, community representatives, and our non-Indigenous colleagues in this important conversation.
Kick off NAIDOC week in Canberra with a Symposium event with keynote speakers and expert panel on the topic of good governance through strong leadership. A daylong event, fully catered with morning and afternoon tea, lunch and post-event drinks and canapes with entertainment to conclude.
This is an exclusive ticketed event in a stunning lakeside venue with limited seats available. Save the date – July 5 – and follow https://www.facebook.com/ailcleaders/ on Facebook to be the first in line to book tickets
6 July National NAIDOC Awards Canberra
7 -14 July 2019 National NAIDOC Grant funding round opens
VOICE. TREATY. TRUTH.
We invite you to walk with us in a movement of the Australian people for a better future.
The Indigenous voice of this country is over 65,000 plus years old.
They are the first words spoken on this continent. Languages that passed down lore, culture and knowledge for over millennia. They are precious to our nation.
It’s that Indigenous voice that include know-how, practices, skills and innovations – found in a wide variety of contexts, such as agricultural, scientific, technical, ecological and medicinal fields, as well as biodiversity-related knowledge. They are words connecting us to country, an understanding of country and of a people who are the oldest continuing culture on the planet.
For generations, we have sought recognition of our unique place in Australian history and society today. We need to be the architects of our lives and futures.
For generations, Aboriginal and Torres Strait Islander peoples have looked for significant and lasting change.
Voice. Treaty. Truth. were three key elements to the reforms set out in the Uluru Statement from the Heart. These reforms represent the unified position of First Nations Australians.
However, the Uluru Statement built on generations of consultation and discussions among Indigenous people on a range of issues and grievances. Consultations about the further reforms necessary to secure and underpin our rights and to ensure they can be exercised and enjoyed by Aboriginal and Torres Strait Islander peoples.
It specifically sequenced a set of reforms: first, a First Nations Voice to Parliament enshrined in the Constitution and second, a Makarrata Commission to supervise treaty processes and truth-telling.
(Makarrata is a word from the language of the Yolngu people in Arnhem Land. The Yolngu concept of Makarrata captures the idea of two parties coming together after a struggle, healing the divisions of the past. It is about acknowledging that something has been done wrong, and it seeks to make things right.)
Aboriginal and Torres Strait Islander people want their voice to be heard. First Nations were excluded from the Constitutional convention debates of the 1800’s when the Australian Constitution came into force. Indigenous people were excluded from the bargaining table.
Aboriginal and Torres Strait Islander peoples have always wanted an enhanced role in decision-making in Australia’s democracy.
In the European settlement of Australia, there were no treaties, no formal settlements, no compacts. Aboriginal and Torres Strait Islander people therefore did not cede sovereignty to our land. It was taken away from us. That will remain a continuing source of dispute.
Our sovereignty has never been ceded – not in 1788, not in 1967, not with the Native Title Act, not with the Uluru Statement from the Heart. It coexists with the sovereignty of the Crown and should never be extinguished.
Australia is one of the few liberal democracies around the world which still does not have a treaty or treaties or some other kind of formal acknowledgement or arrangement with its Indigenous minorities.
A substantive treaty has always been the primary aspiration of the Aboriginal and Torres Strait Islander movement.
Critically, treaties are inseparable from Truth.
Lasting and effective agreement cannot be achieved unless we have a shared, truthful understanding of the nature of the dispute, of the history, of how we got to where we stand.
The true story of colonisation must be told, must be heard, must be acknowledged.
But hearing this history is necessary before we can come to some true reconciliation, some genuine healing for both sides.
And of course, this is not just the history of our First Peoples – it is the history of all of us, of all of Australia, and we need to own it.
Venue: Pullman Hotel – 192 Wellington Parade, East Melbourne Vic 3000
Website to be launched soon
23 -25 September IAHA Conference Darwin
A night of celebrating excellence and action – the Gala Dinner is the premier national networking event in Aboriginal and Torres Strait Islander allied health.
The purpose of the IAHA National Indigenous Allied Health Awards is to recognise the contribution of IAHA members to their profession and/or improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.
The IAHA National Indigenous Allied Health Awards showcase the outstanding achievements in Aboriginal and Torres Strait Islander allied health and provides identifiable allied health role models to inspire all Aboriginal and Torres Strait Islander people to consider and pursue a career in allied health.
The awards this year will be known as “10 for 10” to honour the 10 Year Anniversary of IAHA. We will be announcing 4 new awards in addition to the 6 existing below.
24 -26 September 2019 CATSINaM National Professional Development Conference
The 2019 CATSINaM National Professional Development Conference will be held in Sydney, 24th – 26th September 2019. Make sure you save the dates in your calendar.
Further information to follow soon.
Date: Tuesday the 24th to Thursday the 26th September 2019
Location: Sydney, Australia
Organiser: Chloe Peters
Phone: 02 6262 5761
9-10 October 2019 NATSIHWA 10 Year Anniversary Conference
SAVE THE DATE for the 2019 NATSIHWA 10 Year Anniversary Conference!!!
We’re so excited to announce the date of our 10 Year Anniversary Conference – A Decade of Footprints, Driving Recognition!!!
NATSIHWA recognises that importance of members sharing and learning from each other, and our key partners within the Health Sector. We hold a biennial conference for all NATSIHWA members to attend. The conference content focusses on the professional support and development of the Health Workers and Health Practitioners, with key side events to support networking among attendees. We seek feedback from our Membership to make the conferences relevant to their professional needs and expectations and ensure that they are offered in accessible formats and/or locations.The conference is a time to celebrate the important contribution of Health Workers and Health Practitioners, and the Services that support this important profession.
We hold the NATSIHWA Legends Award night at the conference Gala Dinner. Award categories include: Young Warrior, Health Worker Legend, Health Service Legend and Individual Champion.
Watch this space for the release of more dates for registrations, award nominations etc.
16 October Melbourne Uni: Aboriginal and Torres Strait Islander Health and Wellbeing Conference
The University of Melbourne, Department of Rural Health are pleased to advise that abstract
submissions are now being invited that address Aboriginal and Torres Strait Islander health and
The Aboriginal & Torres Strait Islander Health Conference is an opportunity for sharing information and connecting people that are committed to reforming the practice and research of Aboriginal & Torres Strait Islander health and celebrates Aboriginal knowledge systems and strength-based approaches to improving the health outcomes of Aboriginal communities.
This is an opportunity to present evidence-based approaches, Aboriginal methods and models of
practice, Aboriginal perspectives and contribution to health or community led solutions, underpinned by cultural theories to Aboriginal and Torres Strait Islander health and wellbeing.
In 2018 the Aboriginal & Torres Strait Islander Health Conference attracted over 180 delegates from across the community and state.
We welcome submissions from collaborators whose expertise and interests are embedded in Aboriginal health and wellbeing, and particularly presented or co-presented by Aboriginal and Torres Strait Islander people and community members.
closing date for abstract submission is Friday 3 rd May 2019.
As per speaker registration link request please email your professional photo for our program or any conference enquiries to E. firstname.lastname@example.org.
Aboriginal Partnerships and Community Engagement Officer
Department of Rural Health, University of Melbourne T. 03 5823 4554 E. email@example.com
4 November NACCHO Youth Conference -Darwin NT
Darwin Convention Centre
Website to be launched soon
Conference Co-Coordinator Ben Mitchell 02 6246 9309
” This Productivity Commission report was released on 1 February 2019.
It has found that a new National Disability Agreement (NDA) between the Australian, State and Territory Governments is needed to facilitate cooperation, enhance accountability and clarify roles and responsibilities.
We have made a number of recommendations for a new NDA that has at its core the wellbeing and needs of all people with disability and their families and carers. See Part 2 Below
“Did you know the current National Disability Agreement is outdated and doesn’t reflect either the #NDIS or the National Disability Strategy? A new #NDA is needed as a strong positive force to guide future #disability policy.”
” NACCHO lodged a submission to the Parliamentary Inquiry into NDIS Readiness on 22 February 2018. When appropriately resourced, Aboriginal Community Controlled Health Services (ACCHSs) are uniquely placed to support Aboriginal people through the NDIS to improve health and wellbeing outcomes.
However, there are barriers for ACCHSs becoming providers of the NDIS including cost, thin markets as recognised by the Productivity Commission and limited Aboriginal workforce.
See Part 4 below
Part 1 : The Productivity Commission Press Release :New agreement on disability needed to improve the wellbeing of people with disability
The Productivity Commission has called for a new National Disability Agreement (NDA) between all Australian governments to promote cooperation, enhance accountability and clarify roles and responsibilities. A new agreement would help to improve the wellbeing of people with disability, particularly those not covered by the National Disability Insurance Scheme (NDIS), as well as their families and carers.
Commissioner Robert Fitzgerald said, “With so much focus on the NDIS, limited attention has been placed on achieving better outcomes for the many people with disability who are not supported through the NDIS. There’s about 3.8 million people with disability in Australia who are not supported by the NDIS. Most people with disabilities are not and never will be covered by the NDIS yet their rights, needs and aspirations matter”.
The Productivity Commission identified in a report released today that the disability policy landscape has changed dramatically since the current agreement commenced a decade ago and much of what is in it is now outdated and irrelevant. In particular, the current agreement does not reflect the implementation of the NDIS or the National Disability Strategy.
“There has been very little progress in meeting previously agreed goals such as raising labour force participation rates for people with disability or improving the wellbeing of carers. We have identified key gaps in the areas of advocacy services, support for carers, and supports for people with disabilities arising from mental health conditions, as well as access to community and inclusion programs,” Commissioner Fitzgerald said.
The Commission’s report concludes that a new, reinvigorated NDA could be a strong positive force to guide future disability policy, to promote better access to mainstream and disability services and to improve outcomes for people with disability.
The Commission recommends that the new NDA clearly set out the responsibilities of governments to provide disability services outside the NDIS, and to affirm the commitment of governments to address service gaps and barriers that people with disability face in accessing mainstream services.
“Improving the wellbeing of all people with disability, their families and carers requires a collaborative response from all levels of government, extending well beyond the NDIS to many other service systems such as housing, transport, health, justice and education,” Commissioner Fitzgerald said.
The Commission also recommends that the new NDA set out a single, strengthened national performance reporting framework, with progress towards the outcomes of the new NDA publicly disseminated via a new National Disability Report, to be tabled in Parliament every two years.
The full study report about the National Disability Agreement Review can be accessed from the Commission’s website at http://www.pc.gov.au. This is the first of the Commission’s reviews of nationally significant sector-wide agreements between the Australian and State and Territory Governments.
In 2008, the Australian and State and Territory Governments agreed on a new framework for federal financial relations, to provide a foundation for collaboration on policy and service delivery, and to facilitate the implementation of reforms in areas of national importance. The centrepiece of this arrangement was the establishment of six National Agreements covering disability, education, health, housing, Indigenous reform, and skills and workforce development.
The Australian Government has asked the Productivity Commission to review nationally significant sector‑wide agreements, beginning with the National Disability Agreement (NDA) (box 1). The Commission was asked to consider the relevance of the agreement in the context of contemporary policy settings and whether it needs updating in light of these.
The current National Disability Agreement (NDA) no longer serves its purpose, has a weak influence on policy, and its performance targets show no progress in improving the wellbeing of people with disability. A new agreement is needed to promote cooperation, enhance accountability and clarify roles and responsibilities of governments.
The disability policy landscape has changed markedly since the NDA was signed in 2008.
The National Disability Insurance Scheme (NDIS) commenced in 2013, focusing on supports for approximately 475 000 people with significant and permanent disability. And the National Disability Strategy (NDS), which covers all people with disability (approximately 4.3 million), was endorsed by all Australian Governments in 2011.
Improving the wellbeing of people with disability and carers across the nation requires a collaborative response from all levels of government, extending well beyond the NDIS to many other service systems, such as housing, transport, health, justice, and education.
There is an important role for a new NDA that has at its core, the wellbeing and needs of all people with disability and their families and carers. The purpose of a new NDA would be to provide an overarching agreement for disability policy, to clarify roles and responsibilities, to promote cooperation and to enhance accountability.
The new NDA should:
set out the aspirational objective for disability policy in Australia — people with disability and their carers have an enhanced quality of life and participate as valued members of the community — and acknowledge and reflect the rights committed to by Australia under the United Nations Convention on the Rights of Persons with Disabilities
outline the roles and responsibilities of governments in progressing that objective; the outcomes being sought for people with disability; and a nationally consistent performance reporting framework for tracking progress against those outcomes.
The NDS should continue to play the essential role of articulating policy actions, with these actions explicitly linked to the new NDA’s outcomes.
The agreements governing the NDIS would remain separate to the NDA, but should be referenced throughout so that the NDA is reflective of the whole disability system.
Roles and responsibilities in the NDA need to be updated to reflect contemporary policy settings, to reduce uncertainty and to address gaps in several areas — including in relation to advocacy, carers, and the interface between the NDIS and mainstream service systems.
To facilitate greater clarity in responsibilities, governments should articulate and publish which programs they are rolling into the NDIS and how they will support people with disability who are not covered by the NDIS. They should also (through the COAG Disability Reform Council (DRC)) undertake a comprehensive gap analysis, with the new NDA outlining responsibilities for addressing any gaps. A gap analysis should be undertaken every five years.
NDA performance reporting needs strengthening to improve transparency and accountability.
There should be a single person‑centred national performance reporting arrangement across the NDA and NDS, with performance indicators and targets agreed to by the DRC.
A ‘National Disability Report’ should be tabled in Parliament biennially, outlining progress against the NDA’s outcomes and performance metrics, and including the perspectives of people with disability and findings from policy evaluations undertaken as part of the NDA.
A new NDA should be agreed by the start of 2020. It should be a living document, with updates made to schedules as required, and should be independently reviewed every five years.
Part 2 :The Federal Government has welcomes the release of the Productivity Commission’s Final Report of its Review of the National Disability Agreement.
The National Disability Agreement is a high-level accord between the Commonwealth and state and territory governments that sets out roles and responsibilities for the funding and provision of specialist services for people with disability.
“The Australian Government will continue to work with all governments, people with disability and the disability sector to consider the findings and recommendations of the Report as we develop a new strategy,” Minister for Families and Social Services, Paul Fletcher, said.
“With one-in-five Australians living with disability, it is critical for governments to work together to help people with disability take control of their lives and have equal access and opportunity.
“We recognise the disability policy landscape has changed significantly since the agreement was first signed in 2008.
“The findings from this review are highly relevant for informing the design of a new National Disability Strategy for beyond 2020.”
Mr Fletcher said work has already started on developing the new National Disability Strategy for beyond 2020, with public consultation starting later this year.
“We understand the need for a renewed commitment between the Commonwealth and the states and territories,” Mr Fletcher said.
“It is imperative that states and territories continue to provide equal access to mainstream services, such as health, education and transport, so that people with disability can benefit from the same services that are available to, and to which all Australian rely.”
Assistant Minister for Social Services, Housing and Disability Services, Sarah Henderson, said the report reflects the enormous commitment to people with disability by all levels of government, providers, families and carers, and the community.
“We can all acknowledge that people with disability can face challenges with accessing and navigating mainstream services and the report highlights the need for all governments to focus more on overcoming these challenges,” Ms Henderson said.
“The NDIS is one of the biggest social reforms in Australian history and represents a very significant change to the way people with disability access support.”
The NDIS was never intended to replace all services that state and territory governments provide for people with disability, nor does it remove state and territory responsibility for providing disability support for people under 65 (under 50 for Aboriginal and Torres Strait Islander people) who are not eligible for the NDIS.
More than 250,000 Australians are now being supported by the NDIS including 78,000 receiving life-changing supports for the first time. As at 30 September 2018, 91 per cent of NDIS participants were also accessing mainstream services and supports.
Part 3 : The Australian Federation of Disability Organisations (AFDO) fully supports the recommendations and commends the Productivity Commission in its latest review outcomes into the National Disability Agreements (NDA).
AFDO urges the Federal Government and every State & Territory government to adopt these recommendations and through the Council of Australian Governments (COAG) commence building these recommendations into a new NDA inclusive of relevant funding, outcomes and reporting.
“I commend the work and the depth of consultation which Commissioner Robert Fitzgerald and the Productivity Commission team have undertaken which is reflected in the richness of the recommendations, they have nailed it!, said Mr Joyce, CEO of AFDO.
“We have been very concerned about the ongoing confusion over responsibilities and service provision across jurisdictions following the implementation and roll-out of the National Disability Insurance Scheme (NDIS) particularly for the 4+ million Australians with disability who are not and never will be covered by the NDIS. The NDIS is essential and will cover 460 thousand Australians at full roll-out, those outside of this and ineligible to join still need relevant supports across all communities. All State & Territory Governments have an ongoing responsibility to people with disability to provide relevant services and supports, no different to anyone else”, advised Mr Joyce.
“The Productivity Commission has investigated and provided key, pertinent and practical recommendations which will ensure that new National Disability Agreements will be an overarching agreement covering all people with disability. The new Agreements need to be about meeting the rights, needs and aspirations, of all people with disability in Australia, and reflect the role of the National Disability Strategy and the NDIS. This is welcomed and would create a new dynamic for people with disability and bring about greater inclusion.”
“We need the Federal Government and all State/Territory Governments to get on board, endorse these and ensure that agreed funding is provided to enable implementation in an effective and timely manner”, said Mr Joyce.
NACCHO lodged a submission to the Parliamentary Inquiry into NDIS Readiness on 22 February 2018. When appropriately resourced, Aboriginal Community Controlled Health Services (ACCHSs) are uniquely placed to support Aboriginal people through the NDIS to improve health and wellbeing outcomes.
However, there are barriers for ACCHSs becoming providers of the NDIS including cost, thin markets as recognised by the Productivity Commission and limited Aboriginal workforce. The submission also highlights the barriers many Aboriginal people face in accessing NDIS services which include not fitting the assumed client model, limited NDIS service providers in rural and remote areas and not catering for the specific needs of Aboriginal culture.
NACCHO is supportive of the NDIS and understands it is a complex and highly valued national reform. If implemented well, the NDIS will substantially improve the health and wellbeing of people with a disability and Australians more generally. We are keen to collaborate with the Commonwealth Government to develop better solutions for Aboriginal people with a disability.
The full submission to the Parliamentary Inquiry including recommendations for improvement can be found here – NACCHO NDIS submission
” 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).”
“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.
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.
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 healthproblem 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.
” In 2014 the Australian government commenced rolling out the NDIS. But Aboriginal participation in the new scheme remains unacceptably low.
This means that despite increases in the funding available, there is a real danger that without culturally appropriate services, supports and pathways the Aboriginal community will not get access to all of the opportunities that the NDIS represents.
Daily our mob lives with the impacts of disability more than any other section of the Australian population: almost half of our Indigenous population aged 15 years and over live with disability or a restrictive long-term health condition and experience disability at more than twice the rate of the general Australianpopulation which increases further with the inclusion of psychosocial disability (mental health).
We need solutions to ensure that all Aboriginal people and their families have access to quality disability services that respect their culture and meet their needs.”
Joseph Archibald is a Gamilario man living on Birpai country mid-north NSW coast. He is manager of Windaan Aboriginal Services. Joseph has worked in the disability sector across areas including sector capacity building for Aboriginal engagement and Aboriginal employment and workforce strategy with industry peak National Disability Services (NDS) and NDIS service development with Galambila Aboriginal Health Service
” Commonwealth Ombudsman Michael Manthorpe today released a report into the National Disability Insurance Agency’s (NDIA) handling of reviews of decisions under the National Disability Insurance Scheme Act 2013 highlighting complaints and stakeholder feedback including significant backlogs, delays in decision making and poor communication practices.”
In releasing the report, Mr Manthorpe acknowledged the considerable pressure the NDIA has been under to meet bilateral targets since the national rollout of the NDIS, which began in July 2016.
However, the Ombudsman stressed this must not be used as a reason to deprioritise or delay other work, including reviews.
“It is clear from this report there are a number of areas in which the NDIA can, and should improve its administration of participant-initiated reviews. Without significant efforts to improve the timeliness of its approach and its communication with participants, there remains a risk that participants’ rights to review will be challenged and the review process will continue to be unwieldy, unapproachable and the driver of complaint volumes” Mr Manthorpe said.
Since mid-2016, complaints to the Commonwealth Ombudsman about the NDIA’s review process have represented around 32 per cent of all NDIA complaints.
The report makes 20 recommendations aimed at improving the NDIA’s administration of reviews, all of which were accepted by the NDIA. The Ombudsman’s Office will continue to monitor the implementation of the recommendations in the report, which is available at:
Media Part 2
People with disabilities are facing delays of up to nine months when they attempt to have their bungled National Disability Insurance Scheme (NDIS) plans fixed, an investigation has found.
The agency not prioritising urgent cases where, for example, people could be at risk of harm or homelessness
NDIA staff and contractors discouraging people from seeking a review
The NDIA not acknowledging requests for review or responding to enquiries
The NDIA has accepted the Ombudsman’s 20 recommendations.
“The NDIA has established a dedicated team to manage outstanding reviews.
Social Services Minister Dan Tehan reinforced the message that the NDIA was dealing with the issues outlined in the report.
“Obviously when you undertake a reform of this scale there will always be issues that we need to work through … we’re doing everything we can to speed up the process.
“”These problems need to be fixed, and fixed right now,” Ms Macklin said.
“Get peoples’ plans right the first time so we just don’t need all these reviews done, and people waiting for much-needed support.”
Federal Labor’s social services spokeswoman Jenny Macklin said it was “an absolutely damning report”.
“This was something that was identified some months ago and special teams have been put in place to address this issue,” he said.
“The NDIS is a world-first reform, the size and scale of which means the scheme will not be without challenges.”
“[The agency] has started determining the most practical way to implement responses,” a spokesman said in a statement.
More than 140,000 Australians are now covered by the NDIS — a number expected to reach 475,000 by early next decade.
Example of AWABAKAL ACCHO NDIS Promotion
You are invited to our FREE information sessions to learn more about the National Disability Insurance Scheme (NDIS).
AWABAKAL NDIS GATHERING
14 June 2018
• 10am to 12pm at Wickham Office…
• 2pm – 4pm at Cardiff Office
We will explain:
• What is the National Disability Insurance Scheme?
• Accessing the National Disability Insurance Scheme.
• What is funded by the National Disability Insurance Scheme?
• What supports are available if I am not eligible for the National Disability Insurance Scheme?
• Your Consumer Rights when accessing Service Providers
• What is a service agreement?
Yarn to people who have been National Disability Insurance Scheme participants for several years about exercising their rights as consumers.
LOCATION: 10am to 12pm 64 Hannell st Wickham
2pm to 4pm 15 Kelton St Cardiff
For further information contact Suzy Trindall – CDAH
M: 0428 840 953 E: firstname.lastname@example.org
Part 3 Aboriginal people with disabilities and their families need our support
Before I worked in the sector, I didn’t know much about disabilities and felt it had little to no relevance to my personal life. How wrong I was. I have been a carer for immediate and extended family and have grown up around family members with disability, but as in many of our Indigenous communities across the country, care and acceptance were our cultural norm and labels were not required.
Pictured above : Editor of NACCHO Communique and Stroke Foundation Consumer Council Co chair & Board Member 2017 Colin Cowell (left ) with fellow stroke survivor Tania Lewis at an NDIS workshop in Coffs Harbour conducted by Joe Archibald (right )
The question of how much of a difference access to quality formal disability supports could have made to the lives of my family members with disability, as well as our lives as carers, is more relevant now then ever.
We need solutions to ensure that all Aboriginal people and their families have access to quality disability services that respect their culture and meet their needs.
The National Disability Insurance Scheme (NDIS) boasts some pretty impressive statistics, including the largest social reform since Medicare, increased funding in the sector from about $8bn per year to $22bn in 2019-20, and providing supports to about 475,000 people.
In 2014 the Australian government commenced rolling out the NDIS. But Aboriginal participation in the new scheme remains unacceptably low. This means that despite increases in the funding available, there is a real danger that without culturally appropriate services, supports and pathways the Aboriginal community will not get access to all of the opportunities that the NDIS represents.
Daily our mob lives with the impacts of disability more than any other section of the Australian population: almost half of our Indigenous population aged 15 years and over live with disability or a restrictive long-term health condition and experience disability at more than twice the rate of the general Australian population which increases further with the inclusion of psychosocial disability (mental health).
Research and statistics demonstrate the overwhelmingly adverse intersectional impact of being Aboriginal and Torres Strait Islander and having disability across a range of wellbeing and social indicators including health, educational attainment, employment participation, personal safety and exposure to the out of home care and criminal justice systems. Indigenous youth in juvenile detention are recorded as having very high rates of significant intellectual disabilities or mental health conditions.
Aboriginal people living with disability, their carers and families need our support.
Every day Indigenous families enter the NDIS system and service marketplace, many with little support and knowledge of what to do and where to go. This will continue as the NDIS evolves and adapts its generic approach, after having already acknowledged more culturally appropriate strategies and pathways are needed to create equity.
There are cohorts of participants for which supply shortages are high-risk due to the increased cost of service provision and limited availability of workforce, including those who: are in outer regional, remote or very remote areas; have complex needs; are from culturally and linguistically diverse backgrounds; are Aboriginal and Torres Strait Islander Australians; or have acute care needs such as in crisis situations.”
For those who have knowledge of the NDIS space you don’t have to look hard to identify the significant risks in becoming a participant or service provider within an evolving scheme. Acknowledging NDIS is a tough market and costs are yet to reflect the “high risk” and specialist service delivery required to achieve effective outcomes, so it is essential to identify what you do well.
We need culturally appropriate services with sustainable models that can compete in the NDIS open market and be around for our communities for the long term.
Seek to collaborate with existing culturally appropriate services.
Our mob still requires a lot of advocacy in the disability space, and services cannot meaningfully address the needs of Aboriginal communities alone. Adopting models that work closely with Aboriginal families and local partner organisations is important, such as our partnership with Galambila Aboriginal Health Services. It complements existing strengths and services pathways to provide comprehensive care coordination across disability, primary health and allied health services. We know that isolating disabilities from our other services does not work in achieving the positive engagement and outcomes for overall health and wellbeing of our communities.
Historically culture and community supports have been excluded from formal disability service provision, but the right supports and services can empower our families to maintain community and culture in services as much as possible.
At Windaan we have made a commitment to weather the storm of NDIS service delivery and seek out partners where our values and vision align. This allows our Indigenous communities to receive services they’re entitled to and deserve.
Guardian Australia is proud to partner with IndigenousX to showcase the diversity of Indigenous peoples and opinions from around the country.
” NACCHO lodged a submission to the Parliamentary Inquiry into NDIS Readiness on 22 February 2018.
When appropriately resourced, Aboriginal Community Controlled Health Services (ACCHSs) are uniquely placed to support Aboriginal people through the NDIS to improve health and wellbeing outcomes.
However, there are barriers for ACCHSs becoming providers of the NDIS including cost, thin markets as recognised by the Productivity Commission and limited Aboriginal workforce.
The submission also highlights the barriers many Aboriginal people face in accessing NDIS services which include not fitting the assumed client model, limited NDIS service providers in rural and remote areas and not catering for the specific needs of Aboriginal culture.
NACCHO is supportive of the NDIS and understands it is a complex and highly valued national reform.
If implemented well, the NDIS will substantially improve the health and wellbeing of people with a disability and Australians more generally.
We are keen to collaborate with the Commonwealth Government to develop better solutions for Aboriginal people with a disability.
From the Aboriginal Community-Controlled Health Sector comprising
Download the full NACCHO Submission HERE or extracts below
The Aboriginal community controlled health sector provides primary health care services to almost half of all Aboriginal people. This paper draws on experience from across our Sector and finds the following.
1.There are problems for many Aboriginal people accessing NDIS services:
Some people struggle because they do not fit the assumed NDIS client model, given that they do not have access to online services, transport or someone who can advocate on their behalf;
Some find the system does not always provide for needs specific to Aboriginal culture (such as sorry business and interpreter services) and is not always welcoming to and respectful of Aboriginal people, and:
Some Aboriginal people, such as those living in remote areas and many regional areas find there are no disability services available at all, let alone the choice of an Aboriginal organisation.
Our members, the Aboriginal Community Controlled Health Services (ACCHSs) are experienced at providing extra assistance to Aboriginal people as needed. They fill out forms on behalf of some clients, help them with housing and justice issues, and provide outreach services and transport. Our members are also well-established and reliable, with some operating for as long as 40 years, and many are accustomed to dealing with multiple different and complex funding arrangements (one Member Service in Western Australia reported they were managing applications and reporting requirements for over 100 State, Commonwealth and private funding agreements).
Many of our ACCHSs are attracted to providing NDIS services to assist the most vulnerable Aboriginal people in their communitiesand to help reduce the cost-shifting they are currently experiencing (when NDIS services are not working for Aboriginal customers, they often seek (unfunded) help from their local ACCHS).
However, there are barriers to our ACCHSs becoming service providers including:
Given the extra costs associated with providing some Aboriginal people with the extra support that they need to interact with the existing NDIS system, the pricing for funded services is too low. It is so low that ACCHSs are choosing not to be providers so that they do not endanger the viability of their existing health services.
There are also problems with the market (the number of participants) being too small to support the competitive provision of services to Aboriginal clients. The problem of ‘thin markets’ was identified by the Productivity Commission some time ago, but this problem has yet to be addressed by the NDIA.
There is insufficient workforce. If our ACCHSs want workers, they find that they need to train their own. Again, this is at cost to the ACCHS.
We also anticipate that many ACCHSs would struggle with the upfront investment needed to start providing NDIS service delivery.
The NACCHO network is very supportive of the NDIS.We understand it is a complex and highly valued national reform that if implemented well, it will substantially improve the wellbeing of people with disability and Australians more generally. We are keen to collaborate with the Commonwealth Government to develop better solutions for Aboriginal people which may include increased NDIS service delivery by our members.
The Aboriginal community controlled health sector
There are 143 Aboriginal Community Controlled Health Services (ACCHSs) who are members of NACCHO. Our members provide services through over 300 clinics. We offer three million episodes of care each year to about 350,000 people, servicing over 47% of the Aboriginal population. About 1 million episodes of care are delivered in remote areas. We employ 6,000 staff, the majority of whom are Aboriginal.
In fact, we are the largest single employer of Aboriginal workers in the country
Aboriginal people are more likely to have a disability but are less likely to access disability services
Aboriginal people are more than twice as likely to experience a disability than non-Indigenous Australians (9% with a severe condition compared to 4% for non-Indigenous).1 Around 60,000 Aboriginal people in Australia have significant disability that could make them eligible for NDIS support, representing 12.5% of potential NDIS participants (while Aboriginal people only represent 3% of the total Australian population).2 We note that currently 5% of NDIS participants are Aboriginal or Torres Strait Islander3, which some consider to be ‘about right’ but we suspect this is far too low.
The percentage of NDIS participants who are Aboriginal is indicative of the numbers of Aboriginal people with plans, but is not necessarily indicative of the extent to which Aboriginal people are receiving assistance under those plans (see box in Section 2 on Indications of under-supply of NDIS services for Aboriginal people).
We welcome the introduction of the NDIS, but are concerned that consistent with previous experience, Aboriginal people may not benefit from the NDIS to the same extent as non-indigenous people.
2.The appropriateness of NDIS arrangements for Aboriginal participants
Based on our experience providing health services, we suspect that Aboriginal people are less likely to use disability services than non-indigenous people owing to:
lack of available disability services, especially in remote areas
lack of available disability services that are culturally competent
lack of accessible disability services (owing to barriers faced by some Aboriginal people including the need to use interpreters, lack of access and skills to use on-line information, needing to travel long distances, not having transport, unstable housing and many other potential issues).
State Governments are withdrawing supports faster than the NDIS can replace them
People who were previously receiving disability support services under State Government schemes are sometimes finding it difficult to obtain replacement services under the NDIS.
NDIS participant planning process is inappropriate for many Aboriginal people
There are significant issues with the NDIS planning process, where participants work with an NDIS planner (who may be either a Local Area Coordinator or an NDIA representative) to develop their care plan based on their ‘reasonable and necessary needs’. NDIS planning conversations are brief and in the past, have sometimes been conducted over the phone and participants were not given adequate time or resources to prepare for their conversations. We understand that some of the issues around the planning process have already been addressed by the NDIA, with the possible exception of the need to provide more pre-planning support by LACs.
It has been reported by our Member Services across the country that NDIA planners are not always sufficiently culturally aware to assist participants appropriately, to understand their goals or to offer them the supports that they need or are entitled to. One example given is that the NDIS is supposed to fund participants’ ability to participate in social and cultural life. Without a proper understanding of Aboriginal culture, planners do not offer or allow for Aboriginal people to choose supports to participate in family, spiritual and traditional cultural practices that are of significant benefit to them
There is a lack of culturally appropriate resources to assist participants and providers. Other services routinely provide interpreters for Aboriginal people but there appears to be no allowance for this under the NDIS. NDIS resources are often in technical language, can require a high degree of computer literacy (and a good internet connection, not always available in remote areas). There are few informational or planning resources specifically tailored to Aboriginal people and their needs.
Lack of case coordination for NDIS participants
Another concern is a lack of organisations who are willing to take on case coordination roles. Where case coordination is funded under an NDIS plan, there is often inadequate allocation of hours in a plan to reflect the amount of support required.
As a result, many Affiliates and Members Services have reported cost shifting to ACCHSs. NDIS participants who have difficulty in the planning process or who cannot access services, often seek help from their local ACCHSs. They trust their local ACCHS to ensure quality, cultural safety and advocacy for Aboriginal people and families that is not adequately provided/funded under the NDIS. ACCHSs are taking on this role at cost to themselves.
Even when Aboriginal people have plans under the NDIS, many are still not receiving the supports to which they are entitled, due to a lack of available providers. There are two aspects to this: a lack of Aboriginal specific or otherwise culturally appropriate disability providers in general, and a lack of any providers at all in parts of regional and remote Australia where Aboriginal people are over-represented and disproportionately suffer from a lack of services.
Thin markets for disability service providers for Aboriginal people
In its recent enquiry into NDIS costs, the Productivity Commission reported on the existence of ‘thin markets’, where the market-based model of the NDIS does not work because there is insufficient supply of participants or disability service organisations to provide a genuine market.
While the Productivity Commission particularly found regional and remote Australia is likely to have thin markets, it also noted that there may be thin markets for Aboriginal specific providers all over Australia, even in urban areas. As an example, one of our members reports that in the ACT, only around 10% (20-40 of 250-300) of eligible Aboriginal people within ACT were accessing NDIS supports under their plans in 2016, in part due to the lack of any Aboriginal specific or culturally safe providers in Canberra.
There are few, if any incentives within the NDIS for service providers to actively work to build community capacity or show that they are able respond to the unique cultural, social and health needs of Aboriginal people. Competitive market models may in fact discourage this. Smaller ACCHSs and other Aboriginal organisations, and particularly those operating in remote areas with thin and fragmented markets, will be unfairly disadvantaged when compared with the economies of scale of larger mainstream providers, including those who operate for profit.
3.Benefits associated with ACCHSs becoming providers of NDIS services
Many of the problems discussed in the previous sections could be addressed if Aboriginal Community Controlled Health Services became providers of NDIS services such as:
Undertaking Local Area Coordinator roles (i.e. developing client plans)
Providing support coordination (i.e. linking up clients with plans to service providers)
Becoming a NDIS registered service provider (i.e. providing disability and allied health services consistent with a client’s plan)
Receiving block grant funding for community engagement and participant access support (including identification and engagement, as well as practical support through eligibility and assessment, pre-planning and planning processes)
As far as we can tell:
Up to 40 ACCHS are providing allied health services to clients paid for by NDIS packages (this is effectively a new source of fee-for-service funding for service delivery already undertaken by ACCHSs). We are unsure how many are registered providers.
Only a few ACCHSs provide the remaining possible services (e.g. LAC services, support co-ordination services or the extensive range of disability services that do not require an allied health professional).
Provision of more disability services by ACCHSs would have the following advantages:
Our Member Services already have a relationship with many Aboriginal people who are or will become NDIS clients.
We specialise in providing services that are accessible.
For those people who need it, we undertake home and community visits, we use available opportunities to treat people (e.g. we treat all attending family members as needed when they visit the clinic), we provide transport and make specialist appointments on behalf of our clients. We also provide wrap around care relating to other services such as housing and justice.
Our Member Services are culturally safe for Aboriginal people.
Our Member Services are reliable. Some of our members have been in operation for over 40 years. Our services have been maintained in rural and remote areas in which other services often fail.
We are accustomed to dealing with funding complexity, with some of our larger ACCHSs juggling requirements from over 100 funding agreements.
4.Barriers to ACCHSs providing NDIS services
However, our ACCHSs are choosing not to become registered providers of NDIS services owing to issues relating to:
i) pricing of services below cost to the provider
ii) lack of available disability workers
iii) need for upfront investment
Pricing of services below cost to the provider
Only a few ACCHSs are becoming registered NDIS providers, as it is not financially viable for most of them to do so and they are not willing to put at risk their organisational viability and/or existing service delivery.
One of the major problems identified is that NDIS funding support is priced at a level that in practice only pays for costs at the point of care as it is based on assumptions about wages, organisational overheads, supervision and billable time that are completely unrealistic and inadequate. In addition, it does not cover holistic care and participant support.
Training and recruitment costs for staff are also problematic for organisations, as training is not funded under the NDIS.
Transport for participants, disability workers and other sundry costs are not sufficiently considered or provided for, especially for regional and remote participants and workers who must travel long distances to access or deliver services.
In general, the remote 25% loading provided by the NDIA is simply inadequate and does not reflect the true costs of providing services in these locations. Our members and other organisations on the ground suggest that 80-100% loading might be more appropriate, given experience in the cost differentials for very remote services.
1.As recommended by the Productivity Commission (2017) in their report, National Disability Insurance Scheme (NDIS) Costs, the National Disability Insurance Agency should address thin markets with a focus on thin markets for disability services suited to the needs of Aboriginal people by:
Considering a range of approaches, including block-funding
A possible funding model could be a case-based model, akin to the model being trialled under the ‘Health Care Homes’ program. Under this model ACCHSs would receive direct funding based on the number of participants they enrol for care and the assessed needs of those participants, along with an amount of block funding to cover organisational transformation and overheads.
As a matter of urgency, publicly releasing its Provider of Last Resort (POLR) policy and Market Intervention Framework discussed in the NDIS Market Approach: Statement of Opportunity and Intent
Collecting and making publicly available disaggregated data, feedback and reports on thin markets, including when POLR arrangements are used.
2.Devote significant investment into training to grow the Aboriginal disability and allied health workforce.
We note that the Government has recently announced the appointment of a consortium led by Ernst and Young to implement its $33 million measure announced in the 2017-18 Budget, Boosting the Local Care Workforce Program. Minister Jane Prentice’s media release (20 December 2017) notes that the consortium includes the First Peoples’ Disability Network. We are keen to know more about the governance of this scheme, what services will be available and whether these will be sufficient.
That the NDIA develop and implement specific processes/standards and training regarding interactions and engagement with Aboriginal and Torres Strait Islander people that respect their cultural practices and ways of doing business, both for planning staff and local area coordinators. Again, NACCHO and the sector could assist.
That the NDIA develop improved pre-planning and reference tools and resources suitable for Aboriginal participants and providers. NACCHO and the sector would be able to assist with the development of these materials (but need to be funded for the capacity to do so).
That the NDIA fund dedicated project officer positions within the sector to assist clients to access the NDIS and advocate for them during interactions with planning officers. These positions must be dedicated within the ACCHO sector to support community engagement and funded on an ongoing basis to have real long-term benefits. Furthermore, positions within the Affiliates are required.
Introduce Aboriginal Cultural Support as a funded support category under the NDIS and/or introduction of weighting of packages for Aboriginal people. This will help ensure the cultural needs of Aboriginal people with disability can be taken into account when planning for access to an ‘ordinary life’. It will also improve the incentives and financial viability of organisations that are Aboriginal specific, or who invest in becoming culturally safe providers.
We need revised standard to become providers as these are complex and administratively onerous.
Undertake an independent review of the impacts of NDIS on Aboriginal and Torres Strait Islander people and how to build an effective system to meet the needs of Aboriginal people.
That DSS consider providing funding to the NACCHO network to help fund the development of policy advice specific to each State on Aboriginal NDIS services.