Access to supports for First Nations communities and all participants in remote communities

There is limited access to supports for remote and First Nations participants
Governments should better coordinate and purchase supports in remote communities and First Nations communities
Governments must share power with First Nations communities
The Panel’s vision: Working in partnership, local communities and governments should design what alternative commissioning looks like
Recommendation 14: Improve access to supports for First Nations participants across Australia and for all participants in remote communities through alternative commissioning arrangements

There is limited access to supports for remote and First Nations participants

For all participants living in remote communities who have been in the scheme for at least one year:

around two in five participants are not getting daily activity supports
over one in three participants are not getting therapy services.²¹⁰

Even in towns and cities, many NDIS services are not culturally appropriate for First Nations people with disability. As a result, First Nations participants may need to choose between supports that are not culturally safe or not getting funded supports at all.

Funding for individuals also 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.

- Jenny Bedford and Cassie Atchison, Disability Royal Commission Public Hearing ²¹¹

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.

- Kim McCrae, Disability Royal Commission Public Hearing ²¹²

Increases in loadings to remote and very remote price limits and greater flexibility in pricing arrangements have helped, but not enough. Past reviews have repeatedly called for different ways to deliver supports. We have found the NDIS cannot rely on ‘competition’ alone to deliver supports to remote communities and First Nations communities.

Governments should better coordinate and purchase supports in remote communities and First Nations communities

The National Disability Insurance Agency (NDIA), First Nations communities, remote communities, other Australian Government agencies and state and territory governments should work together as partners to buy or ‘commission’ supports for people in the community to improve access. We call this ‘alternative commissioning’.

One way which communities may want to coordinate supports is by joining up (or integrating) funding for different supports and community initiatives across government programs. We call this ‘integrated commissioning’.

Integrated commissioning approaches would make it clearer and easier for communities -particularly in remote areas - to understand what services they can access, from who and when. Taking a whole-of-community approach can also minimise duplication and gaps in supports.

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

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. It 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 key priority 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 was developed under the National Agreement for Closing the Gap to support achievement of the priority reform regarding community controlled delivery within the disability sector.²¹³ It also tells governments how they should engage with and respond to the needs of First Nations people with disability. Designing and rolling out alternative commissioning approaches should be no exception.

The Panel’s vision: Working in partnership, local communities and governments should design what alternative commissioning looks like

Ongoing on-the-ground partnerships with First Nations representatives, communities and participants is key. When place-based and driven by communities, alternative commissioning arrangements would mean:

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. More supports would be delivered by people who are part of their community instead of having to rely on people who travel in and out of the community.

This roll out should start as soon as possible with interested communities. It should enable communities and governments to:

build skills and confidence to design and roll out alternative commissioning approaches
learn what approaches and options would work best
understand how joining up different supports - such as foundational supports, navigation supports or aged care - might work best for different communities.

Design and roll out of alternative commissioning approaches should be done in full and genuine partnership with communities, and should build on the strengths and capabilities already in communities. Governments should ensure they meet their commitments under the National Agreement on Closing the Gap when working in partnership with communities. When place-based and led by communities, these approaches can contribute to Closing the Gap by strengthening the community-controlled sector and creating a more sustainable, localised workforce.

These principles, practices and outcomes would come together in an ‘alternative commissioning cycle’.

Figure 12: Alternative commissioning cycle

Recommendation 14: Improve access to supports for First Nations participants across Australia and for all participants in remote communities through alternative commissioning arrangements

* Legislative change required

Action 14.1: The National Disability Insurance Agency, in partnership with First Nations representatives, communities, participants and relevant government agencies should progressively roll-out alternative commissioning arrangements for both First Nations communities and remote communities, starting as soon as possible. The alternative commissioning approaches should be designed in partnership with First Nations representatives, communities and participants, and should be underpinned by governance structures that share decision-making power with communities (see Action 2.10), including First Nations representatives in non-remote communities as well as remote community representatives (which also encompasses the non-Indigenous local population). Alternative commissioning approaches should be based on a commissioning cycle that:
- Is underpinned by an understanding of, and builds on, community strengths and preferences
- Explores and designs commissioning approaches on a case-by-case basis with communities. This could include models of direct and community-led commissioning approaches as well as integrated commissioning (where a provider is commissioned to provide supports across multiple service types)
- Provides culturally appropriate, outcome-based commissioning processes, and
- Uses practical and community-driven processes to collect data and evaluate outcomes.

Access to supports for First Nations communities and all participants in remote communities

On this page

There is limited access to supports for remote and First Nations participants

Governments should better coordinate and purchase supports in remote communities and First Nations communities

Governments must share power with First Nations communities