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    • Premiers to accept federal health-care funding offer, focus turns to bilateral deals

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    Canada's premiers have agreed to accept Prime Minister Justin Trudeau's 10-year health-care funding offer and are now turning their focus towards inking their respective bilateral agreements with the federal government.

    "We've agreed to accept the federal funding," Chair of the Council of the Federation and Manitoba Premier Heather Stefanson said on CTV's Power Play with Vassy Kapelos on Monday.

    The $196.1-billion federal offer to assist ailing health systems presented at an in-person First Ministers' meeting last week includes both increases to the amount budgeted to flow through the Canada Health Transfer (CHT) as well as $25 billion for bilateral deals tailored to each province and territory's health-care system's needs.

    Stefanson said it is the premiers' position that the funding— totalling $46.2 billion in new money—doesn't address all of their concerns, so they still plan to push Trudeau on addressing certain aspects such as long-term sustainability challenges.

    The premiers will be writing to the federal government to raise these issues, such as ensuring fiscal sustainability, so that after the decade-long deals expire, so the amount of money Ottawa sends to the provinces and territories doesn’t fall off a cliff.

    "There's $46 billion on the table right now… $46 billion more than the federal government had on the table before. So that's a step in the right direction," Stefanson said. "We recognize this as a step in the right direction and so we will accept this."

    This decision comes following a virtual meeting attended by premiers on Monday, and after the provincial and territorial leaders had nearly a week to digest Trudeau's proposal and parse the finer print of the accountability expectations placed on them.

    The core planks of the federal offer are:

    • An immediate national and "unconditional" $2-billion top-up to the CHT to address urgent pressures being experienced at pediatric hospitals, emergency rooms and surgical centres;
    • A five-per-cent increase to the CHT over the next five years, provided through the annual top-up, to be rolled into the CHT base after five years to ensure a permanent increase that would provide an estimated $17.3 billion over 10 years;
    • $25 billion over 10 years for decade-long bilateral deals with each province and territory connected to shared priorities such as family health access, investing in mental health and substance abuse services; and modernizing the health information system;

    While Trudeau has billed his government's commitment as "a major federal investment in health care," the early indications were that the offer did not satisfy provinces' demands for a blanket increase to the CHT that would see Ottawa spending an additional $28 billion annually.

    Scott Moe, premier of Saskatchewan, told ۴ý from Regina that the deal wasn't "anywhere near" what they'd requested.

    "That request was for the federal government to become a full funding partner," he said Monday.

    Asked what changed, Stefanson said that Canadians want to see the two levels of government work together to address the pressing concern that is the state of Canadian health care.

    Health Minister Jean-Yves Duclos and Intergovernmental Affairs Minister Dominic LeBlanc are spending time meeting with their counterparts across the country this week, as they look to iron out the details of the bilateral deals over the next few weeks ahead of the 2023 budget.

    LeBlanc said on Sunday's episode of CTV’s Question Period that while he "wouldn't have phrased it" as a take-it-or-leave-it proposal, the total dollar value of the Liberals' offer on the table is final.

    "It's a long term offer, as they had asked for, and we've invited them to begin bilateral conversations with our government to design these agreements for the priorities in their jurisdiction," LeBlanc said.

    On Monday, LeBlanc and Duclos said in a joint statement that they "welcomed" the decision and that discussions with the provincial and territorial ministers are "rooted in how we can work together to improve health care for patients."

    The ministers pledged a continued collaboration between the levels of government but did not give any details on what that would look like.

    The federal government has asked provincial and territorial governments to develop "action plans" describing how they plan to use the funding and measure improvements to their systems.

    Among the metrics the federal government says it will be looking at to assess whether tangible progress comes from the bilateral funding arrangements are:

    • The net new family physicians, nurses, and nurse practitioners in each province and territory;
    • The percentage of Canadians who have access to a family health team or family doctor;
    • The size of the COVID-19 surgery backlog;
    • The median wait times for community mental health and substance abuse services; and
    • The percentage of Canadians who can access their health records electronically.

    Duclos, who was in Halifax with LeBlanc as the pair negotiated the terms of the deal tailored for Nova Scotia, spoke of the strings attached, including that the provinces need to share data showing the money is making a difference.

    "We believe that, yes, dollars mattered. But for those dollars to have any sense, they need to be translated into real outcomes," he said.

    Stefanson said that in signing these deals, premiers want to make sure that the programs that receive federal funding for the next decade won’t be in jeopardy down the line.

    "In the past, some of the some of the money for bilateral agreements has gone into the baseline funding, so into the Canada Health Transfer… to ensure there's continuity when it comes to making sure those health-care services will continue to be delivered," she said. "We just want to make sure that [the deal] has a longer term sustainable funding for the future."

    Michael Decter, former Ontario deputy health minister, says that while the deal may be less than what the premiers hoped for, it's enough to make a difference if used properly.

    "I would start earlier with primary care health-care teams," he said in reference to a system of care that provides patients access to a variety of professionals, such as nurse practitioners and registered nurses, in addition to their family doctor.

    "We need teams rather than solo practice family doctors at the base of the system because, without them, you've got all sorts of people who just go straight to the emergency room," he said.

    With files from CTV National News Senior Political Correspondent Glen McGregor

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