Recommendation: That the B.C. government apologize for Indigenous-specific racism in the health-care system, setting the tone for similar apologies throughout the health system, and affirm its responsibility to direct and implement a comprehensive, system-wide approach to addressing the problem, including standardized language and definitions, and clear roles and responsibilities for health authorities, regulatory bodies, associations and unions, and educational institutions.

Progress: In his verbal apology on Nov. 30, 2020, Minister of Health Adrian Dix noted he would recommend to Premier Horgan that they both, “sit down immediately to work out our government’s response to meet the report’s first recommendation and set us on a path to healing and reconciliation,” and noted that this would be planned alongside First Nations and Métis partners. This cross-government work is now in the preliminary stages with the Ministry of Health and the Office of the Premier, and will be forthcoming.

Recommendation: That the B.C. government, in collaboration and co-operation with Indigenous peoples in B.C., develop appropriate policy foundations and implement legislative changes to require anti-racism and “hard-wire” cultural safety, including an anti-racism act and other critical changes in existing laws, policies, regulations and practices, ensuring that this effort aligns with the UN Declaration as required by the Declaration on the Rights of Indigenous Peoples Act.

Progress: There is work underway related to improving accountability and ensuring culturally safe complaints systems. This includes requirements for legislative reform intended to strengthen the complaints processes and requirements for colleges, health professionals and others. While legislative changes take time, changes are underway at the operational level to strengthen and align processes now.

Recommendation: That the B.C. government, First Nations governing bodies and representative organizations, and Métis Nation BC jointly establish the Office of the Indigenous Health Representative and Advocate with legislative recognition and authority to provide a single, accessible, supportive, adequately funded resource for early intervention and dispute resolution for Indigenous people who require assistance to navigate, fully benefit from, and to resolve problems within, B.C.’s health-care system including all health authorities, regulatory colleges and other health providers. The position should be reviewed in five years after establishment to determine if it has been effective in rooting out racism in the health-care system in B.C.

Progress: There is work underway related to improving accountability and ensure culturally safe complaints systems. This includes requirements for legislative reform intended to strengthen the complaints processes and requirements for colleges, health professionals and others. While legislative changes take time, it does not prevent from making changes at the operational level to strengthen and align our processes now.

Recommendation: That the B.C. government, First Nations governing bodies and representative organizations, and MNBC jointly develop a strategy to improve the patient complaint processes to address individual and systemic Indigenous-specific racism.

Progress: There is work currently underway related to improving accountability and ensure culturally safe complaints systems. This includes requirements for legislative reform intended to strengthen the complaints processes and requirements for colleges, health professionals and others. While legislative changes take time, it does not prevent from making changes at the operational level to strengthen and align our processes now.

Recommendation: That all health policy-makers, health authorities, health regulatory bodies, health organizations, health facilities, patient care quality review boards and health education programs in B.C. adopt an accreditation standard for achieving Indigenous cultural safety through cultural humility and eliminating Indigenous-specific racism that has been developed in collaboration and co-operation with Indigenous Peoples.

Progress: In alignment with recommendation 8, the First Nations Health Authority partnered with the Health Standards Organization to develop a Cultural Safety and Humility Organizational Standard led by a First Nations technical committee. The public review of the newly developed standard closed on Sept. 23, 2021, with publication of the standard being targeted for spring 2022.

Recommendation: That design of hospital facilities in B.C. include partnership with local Indigenous peoples and the Nations on whose territories these facilities are located, so that health authorities create culturally-appropriate, dedicated physical spaces in health facilities for ceremony and cultural protocol, and visibly include Indigenous artwork, signage and territorial acknowledgement throughout these facilities.

Progress: This work has been ongoing since the early 2000s with health authorities creating culturally safe spaces within health-care facilities in consultation with area First Nations.

Recommendation: That the B.C. government continue efforts to strengthen employee “speak-up” culture throughout the entire health-care system so employees can identify and disclose information relating to Indigenous specific racism or any other matter, by applying the Public Interest Disclosure Act (PIDA) to employees throughout the health-care sector without further delay.

Progress: In July 2021, the government announced that health authorities will be included under the Public Interest Disclosure Act effective June 2023, as per recommendation 11, to strengthen employee “speak up” culture.

Recommendation: That the ombudsperson consider including a focus on Indigenous-specific racism in the health-care system as a key priority and seek input from appropriate partners on current plans to strengthen this priority through engagement, special activities to promote greater fairness in public services to Indigenous peoples, and reporting to the public on progress.

Progress: There is work underway related to improving accountability and ensure culturally safe complaints systems. This includes requirements for legislative reform intended to strengthen the complaints processes and requirements for colleges, health professionals and others. While legislative changes take time, it does not prevent from making changes at the operational level to strengthen and align our processes now.

Recommendation: That the B.C. government establish the new position of associate deputy minister for Indigenous health within the Ministry of Health, with clear authorities including supporting the deputy minister of health in leading the ministry’s role in implementing these recommendations.

Progress: This was achieved with the appointment of Dawn Thomas to the role of acting associate deputy minister, Indigenous Health.

Recommendation: That the B.C. government, Provincial Health Services Authority (PHSA), the five regional health authorities, B.C. colleges and universities with health programs, health regulators, and all health-service organizations, providers and facilities recruit Indigenous individuals to senior positions to oversee and promote needed system change.

Progress: There have been concerted efforts across the health system to support the recruitment and retention of Indigenous staff and leadership. All the health authorities – except Fraser Health who is currently in the hiring process including PHSA and Providence Health and Fraser Health in the hiring process, have hired VPs of Indigenous Health.

Recommendation: That the B.C. government and First Nations Health Authority (FNHA) demonstrate progress on commitments to increase access to culturally safe mental health and wellness and substance use services.

Progress: Together with FNHA, the ministry has commitments to increase access to culturally safe mental health and wellness to support the FNHA with the replacement of First Nation-run treatment centres throughout B.C. 

Extensive funding support for land-based and culturally safe treatment services, and the a commitment by the Province, the Government of Canada and the FNHA to support the implementation of a new tripartite partnership for mental health and wellness. 
Further funding includes supporting provincial overdose emergency response for First Nations communities, Métis-led mental health and wellness initiatives, and overdose prevention grants in rural remote and Indigenous communities.

Recommendation: That the B.C. government require all university and college degree and diploma programs for health professionals in B.C. to implement mandatory strategies and targets to identify, recruit and encourage Indigenous enrolment and graduation, including increasing the safety of the learning environment for Indigenous students.

Progress: The Ministry of Advanced Education and Skills Training is working closely with the Ministry of Health’s Office of Indigenous Health to develop a workplan to respond to In Plain Sight report recommendations that are embedded in post-secondary education. The workplan will be developed in consultation and cooperation with Indigenous partners including the First Nations Education Steering Committee, the Indigenous Adult and Higher Learning Association, and MNBC, as well as post-secondary institutions, the In Plain Sight Task Team and other key stakeholders.

Recommendation: That a centre for anti-racism, cultural safety and trauma-informed standards, policy, tools and leading practices be established and provide open access to health-care organizations, practitioners, educational institutions and others to evidence-based instruments and expertise and to expand the capacity in the system to work collaboratively in this regard.

Progress: A national knowledge exchange repository has been established in partnership with the National Collaborating Centre for Indigenous Health (NCCIH), housed at University of Northern BC and supported by Indigenous Services Canada (ISC) and the Ministry of Health. NCCIH will house a collection of cultural safety, anti-racism and trauma-informed standards, policy, tools, and leading practices. This was announced on Aug. 13, 2021.

Recommendation: That all B.C. university and college degree and diploma programs for health practitioners include mandatory components to ensure all students receive accurate and detailed knowledge of Indigenous-specific racism, colonialism, trauma-informed practice, Indigenous health and wellness, and the requirement to provide service to meet the minimum standards in the UN Declaration.

Progress: The Ministry of Advanced Education and Skills Training is working closely with the Ministry of Health’s Office of Indigenous Health to develop a workplan to respond to In Plain Sight report recommendations that are embedded in post-secondary education. The workplan will be developed in consultation and co-operation with Indigenous partners, including the First Nations Education Steering Committee, the Indigenous Adult and Higher Learning Association, and MNBC, as well as post-secondary institutions, the In Plain Sight Task Team and other key stakeholders.

Recommendation: That the B.C. government, in partnership with First Nations governing bodies and representative organizations, MNBC, Indigenous physicians, experts, and the University of British Columbia or other institutions as appropriate, establish a joint degree in medicine and Indigenous medicine. That the B.C. government, in partnership with First Nations governing bodies and representative organizations, MNBC, Indigenous nurses, experts and appropriate educational institutions, establish a similar joint degree program for nursing professions.

Progress: The Ministry of Advanced Education and Skills Training is working closely with the Ministry of Health’s Office of Indigenous Health to develop a workplan to respond to In Plain Sight report recommendations that are embedded in post-secondary education. The workplan will be developed in consultation and co-operation with Indigenous partners, including the First Nations Education Steering Committee, the Indigenous Adult and Higher Learning Association, and MNBC, as well as post-secondary institutions, the In Plain Sight Task Team and other key stakeholders.

Recommendation: That the B.C. government establish a task team to be in place for at least 24 months after the date of this report to propel and ensure the implementation of all Recommendations, reporting to the Minister of Health and working with the deputy minister and the associate deputy minister for Indigenous health, and at all times ensuring the standards of consultation and co-operation with Indigenous Peoples are upheld consistent with the UN Declaration.

Progress: The In Plain Sight Task Team (a group of First Nations and Métis leaders, health-system partner leaders and health-care experts from around the province), came together in May 2021. The task team has begun working with health-system and government partners to guide the implementation of the 24 In Plain Sight recommendations to make culturally safe health care a reality for all British Columbians. As the work of implementing the recommendations continues to move forward, the Task Team will demonstrate future progress through public reporting and the Task Team and Ministry of Health anticipate publishing their first annual report early in 2022. This was announced on September 2021.