Advisory or Authority: What decides whether Indigenous governance is real
By Jayde Fuller
If your organisation has an Aboriginal and Torres Strait Islander advisory group — and most health organisations in this country now do — here is a question worth sitting with.
Name one decision that group made in the last twelve months that your executive could not have overturned.
Not a decision the executive happened to agree with. Not a recommendation that was accepted. One decision that stood because no one in the organisation had the authority to reverse it.
I put that question to health regulators a few weeks ago, and I expected an argument. I thought I would be told it was unfair. That it was too narrow. That influence works differently, and this isn't how governance is measured.
That isn't what happened.
What came back was recognition. People who sit on these committees answered. People who helped establish them answered. Nobody defended the structure. One reader pointed out that the same question could be put to government departments, which is true, and worse.
Recognition is a stranger result than disagreement.
When you name something as a failure and the people closest to it decline to defend it, you have not found a failure. You have found a design that everybody recognises and nobody has had a reason to examine.
Kaurna and Narungga man, Curtis Falla put it more precisely than I had: are we sharing governance, or merely sharing participation?
That is the subject of this piece. Not whether Indigenous people are in the room. In most health organisations, we are. Whether being in the room does anything.
I'm going to use health regulation as the worked example — it's the system I know from the inside, and it holds the single strongest case anywhere in the world of an institution doing this properly. But nothing in the argument belongs only to regulators. If you sit on a hospital and health service board, a primary health network, a university faculty, a research institute or a government department, it is the same test.
The thing that isn't broken
There is an assumption buried in how we usually answer that question, and it's worth pulling out and looking at properly.
The assumption is that an advisory group is an incomplete version of governance. That someone set out to share power, got part of the way, and stopped — through timidity, or budget, or not knowing how. On that reading the fix is obvious. Finish the job. Strengthen the terms of reference. Appoint a better chair. Add seats.
I don't think that's what happened.
An advisory body is not a governance structure that fell short. It's a different structure altogether, and it works extremely well. It has spread across health organisations in Australia, Aotearoa and Canada alike for the same reason any efficient design spreads. It delivers.
Look at what it reliably produces.
It produces legitimacy — the ability to say, accurately, that the work was done with Indigenous people.
It produces cultural cover — a named body to point to when a decision is challenged.
It produces expertise, genuinely and cheaply, from people who know things the organisation does not, with no obligation attached to what they say.
And it produces deniability. It went to the committee survives almost any scrutiny, including scrutiny from people who suspect it shouldn't.
Four things an institution needs. Not one of them requiring the executive to give up anything at all. I put it more bluntly in The Blueprint: the power to ignore what you have been told stays entirely intact.
That isn't a failure. It's one of the most efficient arrangements in institutional life. It's why nobody ever had to campaign for advisory groups — they propagated on their own, the way a good design does. And they're stable, because no part of the organisation has any interest in destabilising them.
Which brings me to the part I want to be careful about.
Nobody chose this. The people who sit on these committees are doing exactly what they were asked to do, often at real cost to themselves. The executives who established them mostly meant it. The design does its work without anyone in the chain having decided on the outcome — which is what makes it structural rather than moral, and why arguing about intent gets nowhere.
But it also means the obvious fix isn't one.
A stronger chair, clearer terms of reference, more seats at the table — these improve the quality of the advice. Every one of them is worth doing. Not one of them changes what happens on the day the advice is unwelcome.
That day is the only test that matters. And the structure already knows the answer.
What authority requires
So it's worth being exact about what the alternative is.
Authority is the capacity to produce an outcome that survives the disagreement of the person who would prefer otherwise.
In The Blueprint I called this the first of two thresholds — an actual relinquishment of decision-making authority over the lives, care and futures of Indigenous Peoples. That is the principle. What follows is the plumbing.
Everything short of that is influence. Influence is not nothing — it is often how the best work gets done, and I have relied on it for most of my career. But influence is contingent on the goodwill of the person being influenced, and goodwill is not a governance mechanism. It is a relationship, and relationships change with the people in them.
Which means the whole question resolves on a single day: the day the executive would rather not.
Five things determine what happens on that day. None of them is exotic. Every one of them is a choice an organisation has already made in other parts of its business.
A delegation instrument, not terms of reference. Terms of reference describe what a group discusses. A delegation transfers a function from the person who holds it to the body that will now exercise it. One is a description. The other is a transfer.
Reserved matters. A defined list of decisions the executive cannot make alone, where the body's agreement is a precondition rather than an input.
A statutory footing. Policy can be rewritten by the people it constrains. Regulation cannot.
Control over its own membership. Who appoints, and who can quietly decline to reappoint.
An independent secretariat. Who funds the staff, and who those staff report to.
Set out like that, it reads as a checklist. It isn't one, and the difference is the whole point.
A delegation without control over membership is revocable by attrition. Nobody has to overturn the decision. They decline to reappoint the person who made it, and the next iteration of the body decides differently.
A reserved matter without an independent secretariat is a reserved matter whose agenda, papers, options and framing are written by the executive it exists to constrain. The body still decides. It decides between options somebody else drafted.
A statutory footing without a delegation is standing without function — a body that exists by law and does nothing by right.
And control over membership, without any of the rest, is a self-selecting group with no work to do.
These are not five features to be collected. They are one mechanism with five parts, and the weakest part sets the ceiling for all of them. Which is how an organisation can hold three of the five, in good faith, and still produce precisely the outcomes it would have produced holding none.
There is an objection at this point, and it is usually raised in good faith: the board carries the legal accountability, so the board cannot be bound. It deserves more than a line, and I'll come back to it another time. Briefly — boards are bound constantly. By statute. By accreditation standards. By enterprise agreements. By the terms of their own audit and risk committees. And every board in this country delegates enormous authority to a chief executive while remaining fully accountable for what that executive does. Accountability for an outcome and authority over every decision are not the same thing.
So the more useful question isn't whether this can be built.
It's whether anyone has built it.
The one that exists
This is where the regulatory example earns its place.
Once. As far as I know, once.
In Australia, the Medical Board and the Nursing and Midwifery Board delegated decision-making to Aboriginal and Torres Strait Islander National Special Issues Committees. The Australian Health Practitioner Regulation Agency (Ahpra) describes it on its own website, in a single paragraph:
The Aboriginal and Torres Strait Islander Health Strategy Unit (HSU) "collaborated with the Medical Board of Australia and the Nursing and Midwifery Board of Australia to delegate decision-making to the Aboriginal and Torres Strait Islander National Special Issues Committees, comprised of Indigenous and non-Indigenous members, who make decisions regarding complaint and compliance matters involving Aboriginal and Torres Strait Islander notifiers and practitioners.”
Read that against the five conditions and the first one is unambiguous. This is not a committee that advises on complaint and compliance matters. It is a committee that decides them, on a function transferred from the Boards that previously held it. The word doing the work is delegate, and it is Ahpra's own word, in the present tense, about its own arrangements.
That matters more than it sounds. Of the five conditions, the delegation is the one that requires a board to actually give something up. The other four determine whether the transfer holds — but the transfer has to happen first, and somebody had to put it to two national boards and have them agree to it.
I led the unit that did that work. I'll leave it there, because what interests me now is not the achievement. It's how little of it can be seen.
The other four conditions cannot be verified from outside. Whether the delegation is instrumented or merely described. Whether there are reserved matters. Whether it rests on anything more durable than policy. Who appoints the members, and who can decline to reappoint them. Who funds the secretariat, and who those staff answer to.
None of that is published. I don't say that as a criticism — it isn't published anywhere, for any committee, in any jurisdiction I've looked at. Governance documents its outputs and not its architecture.
But follow it through. For the strongest example of Indigenous regulatory authority I know of anywhere in the world, a person standing outside the organisation can confirm exactly one of the five things that would tell them whether it is real.
Which means no amount of published commitment will ever answer the question. Not a strategy, not a statement, not an annual report. If the architecture isn't visible, the only way to know what a governance body can actually do is to look at how it was built.
There is one place that took a different route entirely.
British Columbia
In 2011, Canada, British Columbia and the First Nations Health Society signed the Tripartite Framework Agreement on First Nations Health Governance. Under it, a newly created First Nations Health Authority assumed responsibility for the planning, design, management and delivery of the health programs Health Canada had been running for First Nations in that province. In April 2023 the funding agreement behind it was renewed for another decade, at $8.2 billion.
That is not representation inside somebody else's function. It is the function.
Read the agreement and what strikes you is what happened to the Crown's role. Canada did not stop being responsible for First Nations health. It stopped being the designer and deliverer of it. It became a funder and a governance partner — a government that continues to carry the obligation while deferring to First Nations governance on the decisions.
Defer is the word, and it is the whole argument.
Which makes the objection I set aside earlier harder to sustain. If a national government can transfer decision-making authority while continuing to carry accountability for the outcome, a board cannot really claim its own liability makes the same thing impossible.
That renewal is also the answer to anyone who thinks arrangements like this are fragile. The structure has now survived a full ten years and a renegotiation at scale — which is the only real test of whether something was built or merely announced.
And here is what matters for everything I have said so far.
The framework agreement is fifty-seven pages, and you can download it.
Which means an outsider — a community member, a researcher, a journalist, another organisation — can read what was transferred, who holds it, how it is funded, and what each party owes the others. Several of the five conditions are answerable from the public record, because somebody wrote them down and published them.
Set that beside the paragraph I quoted earlier. And remember which of the two is the global high-water mark for regulation.
I want to be careful here, because this comparison can be pushed further than it deserves. The FNHA is a health authority, not a regulator, and its structure does not map cleanly onto what a college or a national board does.
But British Columbia's regulators are not outside this story. On 1 March 2017, the registrars of every college in BC Health Regulators signed a Declaration of Commitment on cultural safety and humility in the regulation of health professionals serving First Nations and Aboriginal people, in partnership with the FNHA. The province has since gone further than any Australian jurisdiction on the legislative side — Canada's adoption of UNDRIP in 2016, then British Columbia's own Declaration on the Rights of Indigenous Peoples Act in 2019, the Health Professions and Occupations Act in 2022, and the Anti-Racism Act in 2024, each of which speaks to Indigenous-specific racism.
So the ground could hardly be better prepared. And still, nine years after that declaration was signed, the decision-making structures sit with the health authorities rather than with the regulators.
The distinction underneath is the transferable one, and it isn't a matter of degree.
Australia's committees hold authority that was lent to them. Real authority, over real decisions — and held, as all delegated authority is, at the pleasure of the body that delegated it.
British Columbia's is held.
But I don't want to leave this as a story about Australia being behind, because it isn't one. In the jurisdiction that went furthest in the world — with the treaties, the legislation, the declaration and the partnership all in place — the health authorities moved and the regulators have not yet.
Not yet is the part I'd hold onto. Being last is a position, not a nature — and it comes with an advantage. The difficult work has already been done next door. British Columbia's five regional health authorities worked out which decisions would move, on what instrument, and with whose agreement. That is the slow, expensive, unglamorous part, and it exists.
So no regulator setting out now is starting from nothing. They are starting from a worked example, in a comparable system, with people who are willing to describe how it was done.
They only have to be willing to ask.
What it costs
I haven't written this to tell anyone what to build. The five mechanisms aren't secret, and every organisation reading this already uses all of them somewhere else in its business.
What's worth naming is the price, because that's the part nobody says out loud.
Every structure that binds takes something specific from an executive. The ability to set the timeline. The ability to choose the framing. The ability to decline without ever having to say so. The ability to be the last word in the room.
Those aren't trivial losses. Pretending they are is why so many of these conversations go nowhere. An organisation unwilling to give them up won't be argued into it — and I would far rather hear that said plainly than hear another commitment.
But the reverse holds too, and it is the whole of what I am saying here.
An organisation that cannot be bound has not shared power. It has shared its time.
So I'll leave you with the question I opened with. Name the decision. If you can, you have built something rare. If you can't, you now know exactly what is missing — and it was never goodwill.
Reference list
Australian Health Practitioner Regulation Agency (Ahpra) n.d., Aboriginal and Torres Strait Islander Health Strategy Unit, Ahpra, viewed 9 September 2026, https://www.ahpra.gov.au/Health-Strategy-Unit.aspx.
BC Health Regulators (BCHR) 2017, Declaration of commitment: cultural safety and humility in the regulation of health professionals serving First Nations and Aboriginal people in British Columbia, BCHR, Vancouver, viewed 9 September 2026, https://bchealthregulators.ca/declaration-of-commitment/.
Canada, Province of British Columbia & First Nations Health Society 2011, British Columbia tripartite framework agreement on First Nations health governance, Government of Canada, Ottawa, viewed 9 September 2026, https://www.sac-isc.gc.ca/eng/1584706392620/1584706415366.
First Nations Health Authority (FNHA) 2017, All regulated health professions commit to a safer health system for First Nations and Aboriginal people, media release, FNHA, Vancouver, March, viewed 9 September 2026, https://www.fnha.ca/about/news-and-events/news/all-regulated-health-professions-commit-to-a-safer-health-system-for-first-nations-and-aboriginal-people.
First Nations Health Council (FNHC) 2023, Canada announces new $8.2 billion funding agreement with FNHA, media release, FNHC, Vancouver, 14 April, viewed 9 September 2026, https://fnhc.ca/news-release-canada-announces-new-8-2-billion-funding-agreement-with-fnha/.
Fuller, J 2026, 'The Blueprint: how health regulatory bodies can move from cultural safety commitment to structural transformation', Croakey Health Media, 12 June, viewed 9 September 2026, https://www.croakey.org/the-blueprint-how-health-regulatory-bodies-can-move-from-cultural-safety-commitment-to-structural-transformation/.
Prime Minister of Canada 2023, Supporting and improving Indigenous-led health care for First Nations in British Columbia, media release, Ottawa, 14 April, viewed 9 September 2026, https://www.pm.gc.ca/en/news/news-releases/2023/04/14/supporting-and-improving-indigenous-led-health-care-first-nations.
Legislation
Anti-Racism Act 2024 (BC).
Declaration on the Rights of Indigenous Peoples Act 2019 (BC).
Health Professions and Occupations Act 2022 (BC).
IRP works with health regulatory bodies on where decision-making authority actually sits, and what it would take to move it. If the question this article opens with is one your organisation can't answer cleanly, that's where a ‘Threshold Assessment’ starts. Email me at jayde@indigenousregulatorypractice.com.au
