How are we working together?
Elements of the In Plain Sight recommendations require different approaches for consultation and co-operation depending on what government ministry is leading the implementation and who the key partners are. Partnership with Indigenous organizations, leaders and communities across the province primarily includes the First Nations Health Authority, Métis Nation BC, the First Nations Health Council, and regional Nation executive tables.
Some recommendations are being pursued primarily through partnerships and actions with the regional health authorities, Provincial Health Services Authority, and Providence Health Care. The approach that each health authority is taking on implementation can be driven by their relationships with First Nations Health Authority, Métis Nation BC and regional Indigenous leaders and governing bodies. While there are significant alignments across the province, each region has a unique structure and processes due to regional context. There are regular working meetings with the Vice Presidents of Indigenous Health from across the health authorities, as well as regular meetings with Métis Nation BC and the First Nations Health Authority.
The Ministry of Health continues to observe and learn from the collaboration and co-operation that other projects and ministries are following, in addition to the guidance provided by the Declaration Act Secretariat, First Nations Health Council, and Métis Nation BC.
The ministry has identified a need to consider Modern Treaty Nations and their unique status as treaty rights holders, as well as urban Indigenous organizations, Elders, youth, and Indigenous Peoples with disabilities in the work ahead. Several First Nations have identified Action 3.07 as a priority in their Declaration Act Engagement Fund workplans, and the ministry is developing an engagement plan for 2025 to meet these needs.
Are there challenges?
The greatest risks to full implementation in a timely manner are:
- competing priorities and pressures across the health system and within Indigenous organizations and communities;
- resourcing across the Provincial government and Indigenous governing bodies for meaningful engagement and partnerships; and
- ongoing systemic silos and structural barriers.
Indigenous communities and First Nations governments have prioritized sustaining and improving the health and wellness of their members. Potential approaches have been considered by Nations and communities to dismantling the legacies of settler-colonial oppression, white supremacy, systemic Indigenous-specific racism, and intergenerational trauma, and more recently the impacts of losses to COVID-19, the toxic drug crisis, and the climate crisis.
These approaches include fostering and maintaining intrinsic connections to culture, language, and land, autonomy and self-determination, and collaboration with Indigenous organizations and partners to develop supportive systems that promote Indigenous Peoples’ ways of knowing and being. An engagement process model is needed that can address the inherent systemic challenges in engaging and collaborating with Indigenous communities and Nation governments.
Highlights
In June 2024, a new superintendent was announced to advance the new health legislation. The role of the superintendent will also serve to ensure the changes made to the Health Professions and Occupations Act advance the key recommendations of the 2020 In Plain Sight Report. For more information, read the “Superintendent chosen to advance new health legislation” news release.
Regulators have now completed their amalgamation work to reduce the number of health profession regulatory colleges from 15 to six. For more information, read the “Patient safety enhanced as more B.C. health colleges amalgamate” news release.
Health Standards Organization and Accreditation Canada continues its partnership with First Nations Health Authority to advance cultural safety and humility through the first assessment of the British Columbia Cultural Safety and Humility Standard. In 2025, Accreditation Canada, with the support of First Nations Health Authority, will lead the first-of-its-kind assessment together with Provincial Health Services Authority. All assessments of the BC Cultural Safety and Humility Standard will be led by First Nations, Inuit and Métis surveyors, including Indigenous patients. For more information, read the “HSO and FNHA to Launch First Assessment of the British Columbia Cultural Safety and Humility Standard” news release.
Previous years’ progress
Highlights
The Ministry of Health’s In Plain Sight (IPS) task team, which included representation from the First Nations Health Authority (FNHA), Métis Nation BC, provincial health authorities and other ministries and health system partners, created to fulfill the obligations of recommendation #24 of the report In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care, concluded their 24-month mandate. The 24-month IPS task team report was publicly released in October 2023.
Monitoring of progress towards full implementation of the IPS recommendations will now happen under Action 3.7, which includes annual reporting to ensure accountability.
The task team members’ knowledge, experience and wisdom have achieved considerable progress on the recommendations and have laid the groundwork with the necessary partners, organizations, and teams to ensure that this collaborative work continues to move forward. The Province recognizes that some of this work will take several years to complete, for example, including new or amended legislation. Some of the significant advances that have been seen within this past year include:
1) Recommendation 1: Health sector collective agreements ratified for 2022-25 (with the Facilities Bargaining Association, the Health Science Professional Bargaining Association, Resident Doctors of BC, the Ambulance Paramedics and Ambulance Dispatchers Bargaining Association, the Community Bargaining Association, and the Nurses Bargaining Association) and the Physician Master Agreement include new provisions to address systemic racism and cultural safety and humility. The new language is a vital first step in creating lasting change by confronting Indigenous-specific racism, promoting cultural safety, identifying and removing collective agreement barriers, and increasing representation of Indigenous employees in the health system. The new provisions include cultural leave and addressing the recruitment and retention of Indigenous employees.
2) Recommendation 2: In June 2023, the provincial government provided significant support with changes such as the inclusion of all health authority employees under the Public Interest Disclosure Act, which makes it easier to denounce racism and discrimination by supporting witnesses to speak up when they see wrong being done.
3) Recommendation 23: The Province’s prospective new medical school at Simon Fraser University will set a new direction by embedding Indigenous knowledge systems in learning, research and practices of healing into the curriculum.
4) Recommendation 22: The Ministry of Education and Child Care (ECC) launched its anti-racism strategy in April 2023 with additional resources for teachers. For the 2023/24 school year, all students working toward a B.C. Certificate of Graduation (“Dogwood Diploma”), in English or French, must successfully complete at least four credits in Indigenous-focused course work.
How are we working together?
The various elements of the recommendations require different approaches for consultation and co-operation depending on who is leading the implementation and who the key partners are. Partnership with Indigenous organizations, leaders and communities across the province primarily include FNHA, MNBC, FNHC, regional partnership tables and the FNLC. Some recommendations are being pursued primarily through partnerships and actions from health authorities. The approach that each health authority is taking on implementation can be driven by their relationships with FNHA, MNBC and regional Indigenous leaders and governing bodies, and while there are significant alignments across the province, each region can have a unique structure and processes that work in that regional context. There are also regular working meetings with the VPs of Indigenous health from across the health authorities as well as regular meetings with MNBC and FNHA. The Ministry of Health continues to observe and learn from the consultation and co-operation pathways that other projects and ministries are following in addition to the guidance provided by the Declaration Act Secretariat, FNHC and MNBC. The Ministry has identified a need to consider Modern Treaty Nations and their unique status as treaty rights holders, as well as urban Indigenous organizations, Elders, youth and Indigenous Peoples with disabilities, in the work ahead.
Are there challenges?
The greatest risks to full implementation in a timely manner are: 1) competing priorities and pressures across the health system and within Indigenous organizations and communities; and 2) finite capacity and resourcing across government and Indigenous governing bodies for meaningful engagement and partnerships. There is recognition that Indigenous organizations and communities and government have finite capacity and multiple competing priorities and crises to manage particularly during the COVID-19 pandemic and climate change issues (i.e. wildfires, floods, etc.).
Highlights
On June 14, 2022, a new Cultural Safety and Humility standard was released. This is the first standard of this type within Canada and was the culmination of years of effort and partnership between the First Nations Health Authority (FNHA), the Health Standards Organization and multiple Indigenous organizations and thought leaders. The standard is currently being used to help guide health system organizations as they work towards improved cultural safety and humility with the intent that this standard will subsequently become part of the suite of accreditation standards that Accreditation Canada uses to assess and accredit health care organizations.
On November 24, 2022, the B.C. government received royal assent for the new Health Professions and Occupations Act to reduce the number of regulatory colleges through amalgamation, reform complaints processes to improve accountability and transparency, commit to cultural safety and humility and improve governance systems. This represents a proactive approach and significant step forward to eliminate discrimination in B.C.’s health care system. Regulated health professionals and regulated occupations under the Act will be required to embed anti-discrimination measures in the delivery of health care services. Discrimination will be a form of professional misconduct or actionable conduct, which will require regulatory colleges to take action against professionals and occupations when they discriminate against others.
Indicators
- Policies/reports developed: First annual progress report on the In Plain Sight recommendations was released December 1, 2022.
How are we working together?
The various elements of the recommendations require different approaches for consultation and co-operation depending on who is leading the implementation and who the key partners are. Partnership with Indigenous organizations, leaders and communities across the province primarily include FNHA, Métis Nation British Columbia (MNBC), First Nations Health Council (FNHC), regional Nation executive tables and the First Nations Leadership Council (FNLC). Some recommendations are being pursued primarily through partnerships and actions from health authorities. The approach that each health authority is taking on implementation can be driven by their relationships with FNHA, MNBC and regional Indigenous leaders and governing bodies. While there are significant alignments across the province, each region can have a unique structure and processes that work in that regional context. There are also regular meetings with the vice presidents from across the health authorities, as well as regular meetings with the board members. The Ministry of Health continues to observe and learn from the collaboration and co-operation pathways that other projects and ministries are following in addition to the guidance provided by the Declaration Act Secretariat.
Are there challenges?
The greatest risks to full implementation in a timely manner are competing priorities and finite capacity across the health system and Indigenous organizations and communities for meaningful engagement and partnerships. The Ministry of Health recognizes that Indigenous Peoples and many other health system partners have not been adequately resourced to meet the competing and increasingly heavy and complex demands on their capacity for full co-operation and collaboration on all issues and opportunities.