Declining water quality and ecological condition is a typical trend for rivers and streams worldwide as human demands for water resources increase. Managing these natural resources sustainably is a key responsibility of governments. Effective water management policies require information derived from long-term monitoring and evaluation. Biological monitoring and assessment are critical for management because bioassessment integrates the biological, physical and chemical features of a waterbody. Investment in nationally coordinated riverine bioassessment in Australia has almost ceased and the foci of management questions are on more localised assessments. However, rivers often span political and administrative boundaries, and their condition may be best protected and managed under national policies, supported by a coordinated national bioassessment framework. We argue that a nationally coordinated program for the bioassessment of riverine health is an essential element of sustainable management of a nation’s water resources. We outline new techniques and research needed to streamline current arrangements to meet present-day and emerging challenges for coordinating and integrating local, regional and national bioassessment activities. This paper draws on international experience in riverine bioassessment to identify attributes of successful broad-scale bioassessment programs and strategies needed to modernise freshwater bioassessment in Australia and re-establish national broad-scale focus.