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Improving access to supports in remote and First Nations communities

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What we’ve heard

The National Disability Insurance Scheme (NDIS) has provided more choice and control for many people with disability. But this is not true for everyone.

The NDIS gives participants funding based on their individual needs. Participants then find and buy the goods and services they need from providers. We call this the NDIS ‘market’.

A ‘one-size-fits-all’ approach to delivering NDIS supports is not working

Not all participants have access to the supports they need from the NDIS ‘market’. Participants can find it hard to search for good services and connect with providers. Providers can find it hard to respond to what participants need.

Sometimes the number of providers or participants in the NDIS is too small for a market to work well or at all. We call this a ‘thin market’.

The National Disability Insurance Agency (NDIA) has tried different ways to improve access to supports in ‘thin markets’. This includes testing in a very small number of areas:

  • providing better information for participants and providers
  • ways to help participants find and buy supports as a group.

So far, what the NDIA has tried has not been enough for all participants to get the supports they need.

Governments must be more active and flexible to help ensure the NDIS market works for everyone.

Things should be done now to improve access to supports in remote and First Nations communities

In Australia, some places are very far away from where most people live, particularly in remote communities. Some participants living in these communities are not getting any supports. For all participants living in remote communities who have been in the Scheme for at least one year:

  • Over one in three participants are not getting daily activity supports
  • Over one in four participants are not getting therapy services.

Even in towns and cities, many NDIS services are not culturally appropriate for First Nations people with disability.

First Nations participants may need to choose between:

  • supports that are not culturally safe or
  • not getting funded supports at all.

Funding for individuals does not consider the strength of communities that participants live in.

Aboriginal Health as … Not just the physical wellbeing of an individual, but the social, emotional and cultural wellbeing of the whole community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their community. It is a whole of life view and includes the cyclical concept of life-death-life.

Joint statement of Jenny Bedford and Cassie Atchison, Disability Royal Commission Public Hearing 25

A narrow focus on the individual, without an understanding of the importance of family and community, conflicts with the Anangu way of living… To help the individual, you often have to support and build the capacity of the family and community… if the NDIS continues to operate without any flexibility to work with families, the scheme will limit individual choice and control for Anangu.

Transcript, Kim McCrae, Disability Royal Commission Public Hearing 25

Past reviews have repeatedly called for different ways to deliver NDIS supports

The NDIS cannot rely on the ‘market’ alone for remote and First Nations communities to access supports.

Supports could be better coordinated by purchasing them for the whole community. Communities and governments can be the ones to buy or ‘commission’ supports for people in the community. We call this ‘alternative commissioning’.

NDIS Review Panel Recommendation

Working together, local communities and governments should design what alternative commissioning looks like. This means:

  • First Nations communities would have more access to culturally safe supports, even in towns and cities. They would choose and control how disability services work for their community.
  • All people in remote communities would access more supports where they live, from people who are part of their community.

Ongoing on-the-ground partnerships with First Nations representatives, communities and participants is key

This roll out should start as soon as possible with communities who want to look at different ways of doing things.

But this approach must done carefully over time.

Throughout, governments must share power with First Nations communities. The National Agreement for Closing the Gap commits all Australian governments to work in full and genuine partnership with First Nations people in making policies. The National Agreement emphasises the importance of four key Priority Reforms:

  • shared decision making
  • community controlled delivery
  • transforming government organisations to be more accountable and responsive
  • providing shared access to data and information at a regional level.

These Reforms are central to ensuring progress and delivering fundamental change. These apply to all government activities involving First Nations communities.

The Disability Sector Strengthening Plan also tells governments how they should engage with and respond to the needs of First Nations people with disability.

Alternative commissioning approaches are no exception.

Together, communities and governments should reflect on what is working well. Doing this will help other communities decide and design what would work best for them. Both communities and governments can:

  • build skill and confidence to design and rollout alternative commissioning approaches
  • learn what approaches and options would work best
  • understand how joining different supports (such as, disability and aged care supports) might work best for different communities.

Success depends on strong and lasting partnerships with people in the community. Organisations which are controlled by communities and disability providers should also learn from each other. This will take time to do properly.

Over time, communities should be supported to look to buy and coordinate supports for themselves. We call this ‘community commissioning’.

Steps for communities to design with governments what works for them

Communities know best what works for them based on what they need where they live.

There are four key steps for communities and governments to design what works for them.

  1. Understand what the community needs and wants. To do this, governments and community should meet.
  2. The community and governments should work together. They should think about and look at different solutions and how they might work.
  3. The community and governments need to partner to decide what works best. Together, they put the chosen solution in place. The solution should:
    • meet the community’s needs
    • be culturally safe for all people in the community, and
    • deliver what the community expects.
  4. Together, the community and government should track how the solution works for the community. This includes:
    • collecting data and information on how it is working
    • reflecting on what is working or not, and
    • make changes to the approach if needed.
Alternative commissioning steps:  Underpinned by First Nations governance- 1. Understand community needs; 2. Explore and design solutions; 3. Put solution in place; 4. Monitor, evaluate and improve

Next steps

Over the coming months, the NDIS Review will continue to work with First Nations representatives, communities and governments to:

  • start building the skills and confidence for governments and communities to work as partners
  • consider 'what good looks like' for alternative commissioning.

When the Review ends, NDIA, other governments, First Nations communities and remote communities will continue to work together. This will include trying out alternative commissioning approaches that communities want.

Visit the Have your say section of our website if you would like to have your say on:

  • how the NDIS is working for participants in First Nations and remote communities
  • alternative commissioning.