The National Disability Insurance Scheme (NDIS) reforms passed this week have raised important concerns for Aboriginal and Torres Strait Islander people with disability, according to researcher Candace Angelo. The reforms must enact the National Disability Insurance Agency (NDIA) commitment for the NDIS to reflect First Nations concepts of disability and wellbeing, and ensure culturally safe and equitable access, power-sharing, cross-sector collaboration, and community-centred approaches as priorities.
The NDIS was built on a powerful principle: that people with permanent and significant disability should have choice and control over the supports they need to live their lives. However, the Scheme needs reform, with growing costs, fraud, and provider exploitation needing to be addressed.
Around one in four Aboriginal and Torres Strait Islander people live with disability, with 25.3 percent of Aboriginal and Torres Strait Islander people having disability and 11.6 percent having a profound or severe limitation in 2022.
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Aboriginal and Torres Strait Islander people encounter disability within health and social systems already shaped by geographical isolation, socioeconomic disadvantage, racism, fragmented service provision, and longstanding underinvestment in community-controlled services. Equity in access to disability support services is critical for addressing health disparities faced by Aboriginal and Torres Strait Islander peoples.
A functional assessment may appear neutral, but it operates within a social and cultural context. The assessment tool must consider the cultural and community contexts of Aboriginal and Torres Strait Islander people, including who asks the questions, in what language, and where the assessment occurs. Research has found that a low level of cultural competence in the initial stages of the disability assessment and planning process exacerbated participant confusion and distrust towards assessment staff and the NDIS.
There are reasonable arguments for reducing reliance on diagnosis alone, as two people with the same diagnosis can have profoundly different support needs. However, replacing one imperfect gateway with another does not automatically create equity, and standardised assessment processes can reproduce disadvantage when they assume culturally universal ideas about communication, self-care, and independence.
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Health assessment tools developed using mainstream or Western concepts may not be relevant in other social contexts, particularly in Aboriginal and Torres Strait Islander communities where concepts of health and wellbeing can be relational and interconnected with family, community, culture, and Country. They require a different approach.
Much of the political debate has focused on people leaving the NDIS and moving towards foundational supports, including children with developmental delay and lower support needs. However, there is a dangerous difference between building an alternative system and assuming one exists, particularly in rural, remote, and Aboriginal communities. It is essential to ensure that the system is genuinely available, accessible, and culturally safe before transitioning participants from the NDIS.
The implications for Aboriginal and Torres Strait Islander children deserve special consideration, as early developmental differences occur within the context of substantial inequities in access to paediatricians, allied health practitioners, diagnostic services, and culturally safe assessment. Children living in regional and remote communities can already wait considerable periods for assessment and intervention, and families may travel hundreds of kilometres for specialist appointments.
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Reform provides an opportunity to correct weaknesses in the NDIS rather than reproducing them in a different form. The NDIS Review recommended alternative commissioning arrangements for First Nations and remote communities, developed in genuine partnership with communities and community-controlled organisations. Governments should specifically resource Aboriginal Community Controlled Organisations to design and deliver foundational disability and developmental supports.
Aboriginal and Torres Strait Islander people with disability must have genuine decision-making authority in the design, validation, and monitoring of new assessment processes. The NDIA’s First Nations Strategy commits the Agency to equitable access, cultural safety, community-centred approaches, and greater power-sharing with Aboriginal and Torres Strait Islander people. The coming reforms will provide a significant test of those commitments.
Governments have an obligation to ensure that the NDIS remains financially sustainable, but they also have an equally important obligation to ensure that reform does not deepen existing disability and health inequities. The two goals should not be positioned as opposites, and Australia can have an NDIS focused on people with substantial and permanent disability while also building strong developmental, community, and foundational supports outside it. The measure of successful NDIS reform cannot simply be slower expenditure growth or fewer participants – it must be whether people with disability are better supported.