Principle 1: Aboriginal people are embedded into decision-making processes and governance structures that impact Aboriginal people in NSW Health

What is the aim of this principle?

This principle aims to:

recognise that when Aboriginal people lead and participate in shared decision making in program and policy design, delivery and evaluation, NSW Health services are more culturally safe and accessible for Aboriginal people
embed Aboriginal people and voices into each level of decision making and governance in NSW Health to achieve better outcomes for Aboriginal people
value, embed and amplify the roles and voices of different Aboriginal people within and in partnership with the NSW Health system, including:
- Aboriginal patients, families and community members across NSW
- Aboriginal NSW Health staff
- ACCOs
- Aboriginal Community Controlled Peak Organisations.

“ I, as one Aboriginal person, can’t be expected to speak on behalf of all Aboriginal people. If I am the only Aboriginal person on a Committee, this isn’t culturally safe.”
ACCHO CEO, Community Controlled Organisation

Why is this important?

To embed the concepts of self-determination and shared decision-making into NSW Health governance structures, Aboriginal people need to be embedded into decision-making processes and governance structures that impact Aboriginal people in NSW Health.

For this principle to be effectively implemented, it is critical that:

NSW Health recognises that shared decision-making requires governments to relinquish some power and authority to make decisions,
Aboriginal people are recognised as equal partners in governance structures to collaborate and co-design decisions, and not a tokenistic part of a consultation process,
Aboriginal voices are embedded into existing NSW Health governance structures, and this is implemented into NSW Health Clinical, Operational and Management Processes.

This principle does not mean that non-Aboriginal people are not responsible for Aboriginal health. The risk in the implementation of this principle is that Aboriginal people, particularly Aboriginal NSW Health staff, have an increased cultural load. This is the invisible workload employers knowingly or unknowingly place on Aboriginal employees to provide cultural knowledge, education and support without any formal alteration to their workload¹².

Rather, this principle focuses on transforming NSW Health systems to empower and enable Aboriginal people to work in partnership with non-Aboriginal NSW Health staff. Non-Aboriginal NSW Health leaders at each level of decision making and governance should work with Aboriginal stakeholders to listen to how they would like to participate in shared decision making to ensure that their cultural load isn’t increased, is acknowledged and that their voice and leadership is heard, amplified and valued to ensure that NSW Health services and programs are culturally safe, responsive and improve outcomes for Aboriginal people.

What does success look like for the NSW Health system?

NSW Health systems, processes and governance structures embed multiple Aboriginal voices at each level of decision making and governance, to ensure that Aboriginal people participate in shared decision making for decisions that impact Aboriginal people. NSW Health systems are transformed to recognise Aboriginal people as equal partners, without increasing the cultural load for Aboriginal people.

There is a standardised section for NSW Health Terms of References for the role and responsibility of identified Aboriginal positions on committees to ensure they are culturally safe and facilitate shared decision making.

“ Having Aboriginal people on [LHD/ SHN] Boards is critical, so that there are Aboriginal voices at the top [of governance structures].”
ACCHO staff member