Canada-Prince Edward Island Agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26)

Tables of contents

Funding agreement
Annex 1 – Common statement of principles on shared health priorities
Annex 2 – Shared pan-Canadian interoperability roadmap
Annex 3 – Headline common indicators
Annex 4 – Action plan

Funding agreement

(the "Agreement")

BETWEEN:

HIS MAJESTY THE KING IN RIGHT OF CANADA (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health and the Minister of Mental Health and Addictions and Associate Minister of Health (herein referred to as "the federal Ministers")

- and -

HIS MAJESTY THE KING IN RIGHT OF THE PROVINCE OF PRINCE EDWARD ISLAND (hereinafter referred to as "Prince Edward Island" or "Government of Prince Edward Island") as represented by the Minister of Health and Wellness (herein referred to as "the provincial Minister")

REFERRED to collectively as the "Parties", and individually as a "Party"

PREAMBLE

WHEREAS, on February 23, 2023, Canada and Prince Edward Island announced an overarching agreement in principle on Working Together to Improve Health Care for Canadians, supported by almost $200 billion over ten years in federal funding, including $46.2 billion in new funding to provinces and territories;

WHEREAS, Canada has also announced a 5 per cent Canada Health Transfer (CHT) guarantee for the next five years, starting in 2023-24, which will be provided through annual top-up payments as required. This is projected to provide approximately an additional $17 billion over 10 years in new support. The last top-up payment will be rolled into the CHT base at the end of the five years to ensure a permanent funding increase, providing certainty and sustainability to provinces and territories;

WHEREAS, Working Together to Improve Health Care for Canadians includes a federal commitment of $25 billion in bilateral funding to provinces and territories over ten years focused on four shared health priorities:

expanding access to family health services, including in rural and remote areas;
supporting our health workers and reducing backlogs;
improving access to quality mental health, substance use, and addictions services; and
modernizing health systems with health data and digital tools.

WHEREAS, in the area of mental health, substance use, and addictions services, Working Together to Improve Health Care for Canadians also includes a commitment by Canada and Prince Edward Island to continue to work to support collaboration on the Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the "Common Statement", attached hereto as Annex 1), supported by the federal Budget 2017 investment of $5 billion over ten years;

WHEREAS, Prince Edward Island has the primary responsibility for delivering health care services to its residents and supports diversity, equity, and the needs of underserved and/or disadvantaged populations, including, but not limited to First Nations, Inuit and Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+;

WHEREAS, Canada authorized the federal Ministers to enter into agreements with the provinces and territories, for the purpose of identifying activities that provinces and territories will undertake in respect of the four shared health priorities, and for funding in this Agreement associated with the federal investment for mental health, substance use, and addictions services consistent with the Common Statement (and menu of actions outlined in Annex 1);

WHEREAS, the Financial Administration Act R.S.P.E.I, c- F-9 authorized the provincial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Prince Edward Island associated with the federal investment for four shared health priorities, and mental health, substance use and addictions services consistent with the Common Statement; and

NOW THEREFORE, this Agreement sets out the terms between Canada and Prince Edward Island as follows:

1.0 Key principles and collaboration

The key principles and commitment to collaboration agreed to in Working Together to Improve Health Care for Canadians are outlined below.

1.1 Canada and Prince Edward Island acknowledge that this Agreement will mutually respect each government's jurisdiction, and be underpinned by key principles, including:

A shared responsibility to uphold the Canada Health Act that strengthens our public health care system;
Principles agreed to in the Common Statement (outlined in Annex 1);
Reconciliation with Indigenous Peoples, recognizing their right to fair and equal access to quality and culturally safe health services free from racism and discrimination anywhere in Canada, including through seamless service delivery across jurisdictions and meaningful engagement and work with Indigenous organizations and governments; and
Equity of access for under-served groups and individuals, including those in official language minority communities.

1.2 Canada and Prince Edward Island acknowledge the importance of supporting health data infrastructure, data collection and public reporting, and will work together to improve the collection, sharing and use of de-identified health information, respecting federal/provincial/territorial privacy legislation, to improve transparency on results and to help manage public health emergencies, and to ensure Canadians can access their own health information and benefit from it being shared between health workers across health settings. This includes:

collecting and securely sharing high-quality, comparable information needed to improve services to Canadians, including disaggregated data on key common health indicators with the Canadian Institute for Health Information (CIHI);
adopting common interoperability standards (both technical exchange and content of data), including the Shared pan-Canadian Interoperability Roadmap (outlined in Annex 2), to improve Canadians' access to their health information in a usable digital format and support the exchange and analysis of health data within and across Canada's health systems in a way that protects Canadians' privacy and ensures the ethical use of data to improve the health and lives of people;
work to align provincial and territorial policies and legislative frameworks where necessary and appropriate to support secure patient access to health information, and stewardship of health information to support the public good, including improving care quality, patient safety, privacy protection, system governance and oversight, planning and research;
promoting health information as a public good by working with federal-provincial-territorial Ministers of Health to review and confirm overarching principles, which would affirm Canadians' ability to access their health information and have it follow them across all points of care. The existing draft Health Data Charter, as outlined in the Pan-Canadian Health Data Strategy would serve as the starting point for the discussion of these principles; and
collecting and sharing available public health data (e.g., vaccination data, testing data) with the Public Health Agency of Canada to support Canada's preparedness and response to public health events, building on commitments made as part of the Safe Restart Agreements.

1.3 Canada and Prince Edward Island acknowledge they will work with other provinces and territories to streamline foreign credential recognition for internationally-educated health professionals, and to advance labour mobility, starting with multi-jurisdictional recognition of health professional licences.

1.4 Canada and Prince Edward Island acknowledge a mutual intent to engage in a two-phased formal review process:

Phase 1: This review will be done in 2026 by a joint committee of Federal, Provincial, and Territorial health and finance officials to assess results and determine next steps for bilateral agreements related to improvements to home and community care, mental health, substance use, and addiction services associated with the Common Statement and long-term care; and
Phase 2: A formal five-year review of the healthcare plan outlined on February 7, 2023, recognizing the importance of long-term sustainability for provincial-territorial health systems. This review would consist of an assessment of both the bilateral agreements (herein) and the CHT investments (not included as part of this bilateral agreement). The review will be done by a joint committee of Federal, Provincial, and Territorial health and finance officials, commencing by March 31, 2027, and concluded by December 31, 2027, to consider results achieved thus far in the four shared health priority areas and will include:
1. an assessment of progress-to-date on public reporting to Canadians using the common indicators;
2. sharing of de-identified health information, and other health data commitments; and
3. current and forward-looking Federal, Provincial, and Territorial investments to support this plan.

2.0 Objectives

2.1 Canada and Prince Edward Island agree that, with financial support from Canada, Prince Edward Island will continue to build and enhance health care systems towards achieving some or all of the objectives of:

timely access to high-quality family health services, including in rural and remote areas;
a sustainable, efficient and resilient health workforce that provides Canadians timely access to high-quality, effective, and safe health services;
access to timely, equitable, and quality mental health, substance use, and addictions services to support Canadians' well-being; and
access to a patient's own electronic health information that is shared between the health professionals they consult to improve safety and quality of care, and which informs Canadians on how the system is working.

2.2 Canada and Prince Edward Island agree that, with Budget 2017 financial support from Canada outlined in 5.2.2, Prince Edward Island will continue to work to improve access to mental health, substance use, and addictions services consistent with the Common Statement (and menu of actions outlined in Annex 1).

3.0 Action plan

3.1 Prince Edward Island set out in their Action Plan (attached as Annex 4) how the federal investment under this Agreement will be used, as well as details on targets and timeframes based on common headline indicators in priority areas where federal funds will be invested, as well as jurisdiction-specific indicators, for each of the initiatives.

3.2 Prince Edward Island will invest federal funding as part of the 2017 commitment for mental health, substance use, and addictions services provided through this Agreement in alignment with the menu of actions listed in the Common Statement.

3.3 Prince Edward Island will invest federal funding in some or all of the four shared health priority areas, without displacing existing planned spending in those areas.

3.4 In developing initiatives under this Agreement, Prince Edward Island agrees to implement measures that also respond to the needs of underserved and/or disadvantaged populations, including, but not limited to First Nations, Inuit and Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+.

3.5 Prince Edward Island's approach to achieving objectives is set out in their three-year Action Plan (2023-24 to 2025-26), as set out in Annex 4.

4.0 Term of agreement

4.1 This Agreement comes into effect upon the date of the last signature of the Parties and will remain in effect until March 31, 2026 ("the Term"), unless terminated in accordance with section 11 of this Agreement. Funding provided under this Agreement will cover the period April 1, 2023 to March 31, 2026.

4.2 Renewal of bilateral agreements

4.2.1 Upon signing renewed bilateral agreements, Prince Edward Island will have access to the remainder of its share of the federal funding, subject to appropriation by Parliament, for:

2026-27, the allocation based on the federal commitment in Budget 2017 of $5 billion over ten years for mental health, substance use and addiction services; and
2026-27 to 2032-33, the allocation based on the federal commitment in Budget 2023 of $25 billion over ten years to support the Working Together to Improve Health Care for Canadians plan.

5.0 Financial provisions

5.1 The funding provided under this Agreement is in addition to and not in lieu of those that Canada currently provides under the CHT to support delivering health care services within the Province.

5.2 Allocation to Prince Edward Island

5.2.1 In this Agreement, "Fiscal Year" means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.

5.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative based on the allocation method outlined in subsection 5.2.3 for the Term of this Agreement.

Working together to improve health care for Canadians

$2.5 billion for the Fiscal Year beginning on April 1, 2023
$2.5 billion for the Fiscal Year beginning on April 1, 2024
$2.5 billion for the Fiscal Year beginning on April 1, 2025

Budget 2017 mental health, substance use, and addictions services

$600 million for the Fiscal Year beginning on April 1, 2023
$600 million for the Fiscal Year beginning on April 1, 2024
$600 million for the Fiscal Year beginning on April 1, 2025

5.2.3 Allocation Method

For the funding associated with Working Together to Improve Health Care for Canadians, annual funding will be allocated to provinces and territories on base ($5,000,000 if population is less than 100,000; $20,000,000 if population is between 100,000 and 500,000; and $50,000,000 if population is greater than 500,000) plus per capita basis. The final total amount to be paid to each jurisdiction will be calculated using the following formula: B + (F - ((N * 5,000,000) + (O * 20,000,000) + (S * 50,000,000)) x (K / L), where:
B is the base amount allocated to each province or territory based on population ($5,000,000 if population is less than 100,000; $20,000,000 if population is between 100,000 and 500,000; and $50,000,000 if population is greater than 500,000), as determined using annual population estimates on July 1^st from Statistics Canada;

F is the total annual funding amount available outlined under this program;

N is the number of provinces and territories with a population less than 100,000, as determined using annual population estimates on July 1^st from Statistics Canada;

O is the number of provinces and territories with a population between 100,000 and 500,000, as determined using annual population estimates on July 1^st from Statistics Canada;

S is the number of provinces and territories with a population greater than 500,000, as determined using annual population estimates on July 1^st from Statistics Canada;

K is the total population of Prince Edward Island, as determined using annual population estimates on July 1^st from Statistics Canada; and

L is the total population of Canada, as determined using annual population estimates on July 1^st from Statistics Canada.
For funds associated with Budget 2017 Mental Health, Substance Use, and Addictions Services, annual funding will be allocated to provinces and territories on a per capita basis. The per capita funding for each Fiscal Year, is calculated using the following formula: F x K/L, where:
F is the annual total funding amount available under this program;

K is the total population of Prince Edward Island, as determined using the annual population estimates on July 1^st from Statistics Canada; and

L is the total population of Canada, as determined using the annual population estimates on July 1^st from Statistics Canada.

5.2.4 Subject to annual adjustment based on the formulas described in section 5.2.3, Prince Edward Island estimated share of the amounts will be:


Fiscal Year	Working Together to Improve Health Care for Canadians Estimated amount to be paid to Prince Edward Island ^{Footnote a} (subject to annual adjustment)	Budget 2017 Mental Health, Substance Use, and Addictions Services Estimated amount to be paid to Prince Edward Island ^{Footnote a} (subject to annual adjustment)
2023-2024	$28,840,000	$2,630,000
2024-2025	$28,840,000	$2,630,000
2025-2026	$28,840,000	$2,630,000
a Amount represent annual estimates based on Statistics Canada's July 1^st, 2022, population estimates. Return to footnote a referrer

5.3 Payment

5.3.1 Funding provided by Canada will be paid in semi-annual installments as follows:

In 2023-2024, the first installment will be paid within approximately 30 business days of execution of this Agreement by the Parties. The second installment will be paid on or about November 15.
Starting in 2024-2025, the first installment will be paid on or about April 15 of each Fiscal Year and the second installment will be paid on or about November 15 of each Fiscal Year.
The first installment will be equal to 50% of the notional amount set out in section 5.2.4 as adjusted by section 5.2.3.
The second installment will be equal to the balance of funding provided by Canada for the Fiscal Year as determined under sections 5.2.3 and 5.2.4.
Canada will notify Prince Edward Island prior to the first payment of each Fiscal Year, of their notional amount. The notional amount will be based on the Statistics Canada quarterly preliminary population estimates on July 1 of the preceding Fiscal Year. Prior to the second payment, Canada will notify Prince Edward Island of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
Canada shall withhold payments if Prince Edward Island has failed to provide reporting in accordance with 7.1.
Canada shall withhold the second payment in 2023-24 if Prince Edward Island has failed to satisfy all reporting requirements associated with the preceding Canada – Prince Edward Island Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23, specifically to:
1. continue to participate in a Federal-Provincial-Territorial process to improve reporting on and provide data to CIHI for the 6 common indicators to measure pan-Canadian progress on improving access to mental health, substance use, and addictions services; and
2. submit an annual financial statement, with attestation from the province's Chief Financial Officer, of funding received the preceding Fiscal Year from Canada for mental health and addiction services under the Canada – Prince Edward Island Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23 compared against the Expenditure Plan, and noting any variances, between actual expenditures and the Expenditure Plan.
The sum of both installments constitutes a final payment and is not subject to any further payment once the second installment has been paid.
Payment of Canada's funding for this Agreement is subject to an annual appropriation by the Parliament of Canada for this purpose.

5.4 Retaining funds

5.4.1 For Fiscal Years 2023-24 through 2024-25, upon request, Prince Edward Island may retain and carry forward to the next Fiscal Year up to 10 percent of funding that is in excess of the amount of the eligible costs actually incurred in a Fiscal Year and use the amount carried forward for expenditures on eligible areas of investment. Any request to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by their designated officials, at the Assistant Deputy Minister level (herein referred to as "Designated Officials"), and is subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis.

5.4.2 Any amount carried forward from one Fiscal Year to the next under this subsection is supplementary to the maximum amount payable to Prince Edward Island under subsection 5.2.4 of this Agreement in the next Fiscal Year.

5.4.3 Upon request, Prince Edward Island may retain and carry forward up to 10 percent of funding provided in the last Fiscal Year of this Agreement for eligible areas of investment, to be noted in the new agreement and subject to the terms and conditions of that new agreement. The new Action Plan will provide details on how any retained funds carried forward will be expended. Any request by Prince Edward Island to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by their Designated Officials, and is subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis.

5.5 Repayment of overpayment

5.5.1. In the event payments made exceed the amount to which Prince Edward Island is entitled under this Agreement, the amount of the excess is a debt due to Canada and, unless otherwise agreed to in writing by the Parties, Prince Edward Island shall repay the amount within sixty (60) calendar days of written notice from Canada.

5.6 Use of funds

5.6.1. The Parties agree that funds provided under this Agreement will only be used by Prince Edward Island in accordance with the initiatives outlined in Annex 4.

5.7 Eligible expenditures

5.7.1. Eligible expenditures under this Agreement are the following:

data development and collection to support reporting;
information technology and health information infrastructure;
capital and operating funding;
salaries and benefits;
training, professional development; and
information and communications material related to programs.

6.0 Performance measurement

6.1 Prince Edward Island agrees to designate an official or official(s), for the duration of this Agreement to participate in a CIHI led Federal-Provincial-Territorial indicator process to:

Refine the eight common headline indicators (outlined in Annex 3);
Work to identify additional common indicators that are mutually agreed upon, including indicators focused on the health of Indigenous populations with acknowledgement of the role for Indigenous partners in this work;
Improve reporting on common indicators to measure pan-Canadian progress on improving access to mental health, substance use, and addictions services, associated with the commitment in the Common Statement; and
Share available disaggregated data with CIHI and work with CIHI to improve availability of disaggregated data for existing and new common indicators to enable reporting on progress for underserved and/or disadvantaged populations including, but not limited to, Indigenous peoples, First Nations, Inuit, Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+.

7.0 Reporting to Canadians

7.1 Funding conditions and reporting

7.1.1 By no later than October 1, in each fiscal year, with respect of the previous Fiscal Year, Prince Edward Island agrees to:

Provide data and information annually to CIHI related to the new headline indicators, additional common indicators, and the mental health, substance use, and addictions services indicators identified as part of commitment made in the Common Statement.
Beginning in Fiscal Year 2024-25, report annually and publicly in an integrated manner to residents of Prince Edward Island on progress made on targets outlined in Annex 4 (Action Plan) for headline indicators in the priority area(s) where federal funds are to be invested, and on jurisdiction-specific indicators for each of the initiatives tailored to their jurisdiction's needs and circumstances.
Beginning in Fiscal Year 2024-25, provide to Canada an annual financial statement, with attestation from the province's Chief Financial Officer, of funding received the preceding Fiscal Year from Canada under this Agreement or the Previous Agreement compared against the Action Plan, and noting any variances, between actual expenditures and the Action Plan:
1. The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year;
2. The total amount of funding used for each of the shared health priority areas that are supported by the federal funds;
3. If applicable, the amount of any funding carried forward under section 5.4; and
4. If applicable, the amount of overpayment that is to be repaid to Canada under section 5.5.

7.1.2 Prince Edward Island will provide quarterly reporting to Canada on the management and spending of the funds retained to the next Fiscal Year.

7.2 Audit

7.2.1 Prince Edward Island will ensure that expenditure information presented in the annual financial statement is, in accordance with Prince Edward Island's standard accounting practices, complete and accurate.

7.3 Evaluation

7.3.1 Responsibility for evaluation of programs rests with Prince Edward Island in accordance with its own evaluation policies and practices.

8.0 Communications

8.1 The Parties agree on the importance of communicating with citizens about the objectives of this Agreement in an open, transparent, effective and proactive manner through appropriate public information activities.

8.2 Each Party will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public.

8.3 In the spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website.

8.4 Prince Edward Island will make publicly available, clearly identified on a Government of Prince Edward Island website, this Agreement, including any amendments.

8.5 Canada, with prior notice to Prince Edward Island, may incorporate all or any part of the data and information in 7.1, or any part of evaluation and audit reports made public by Prince Edward Island into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

8.6 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Canada agrees to give Prince Edward Island 10 days advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

8.7 Prince Edward Island reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Prince Edward Island agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

8.8 Canada and Prince Edward Island agree to participate in a joint announcement upon signing of this Agreement.

8.9 Canada and Prince Edward Island agree to work together to identify mutually agreeable opportunities for joint announcements relating to programs funded under this Agreement.

9.0 Dispute resolution

9.1 The Parties are committed to working together and avoiding disputes through government-to-government information exchange, advance notice, early consultation, and discussion, clarification, and resolution of issues, as they arise.

9.2 If at any time a Party is of the opinion that the other Party has failed to comply with any of its obligations or undertakings under this Agreement or is in breach of any term or condition of the Agreement, that Party may notify the other Party in writing of the failure or breach. Upon such notice, the Parties will endeavour to resolve the issue in dispute bilaterally through their Designated Officials.

9.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada and Prince Edward Island responsible for health, and if it cannot be resolved by them, then the federal Minister(s) and the provincial Minister(s) shall endeavour to resolve the dispute.

10.0 Amendments to the agreement

10.1 The main text of this Agreement may be amended at any time by mutual consent of the Parties. Any amendments shall be in writing and signed, in the case of Canada, by the federal Minister(s), and in the case of Prince Edward Island, by the provincial Minister(s).

10.2 Annex 4 may be amended at any time by mutual consent of the Parties. Any amendments to Annex 4 shall be in writing and signed by each Party's Designated Official.

11.0 Termination

11.1 Either Party may terminate this Agreement at any time if the terms are not respected by giving at least 6 months written notice of intention to terminate.

11.2 As of the effective date of termination of this Agreement, Canada shall have no obligation to make any further payments.

11.3 Sections 1.0, and 8.0 of this Agreement survive for the period of the 10-year Working Together to Improve Health Care for Canadians plan.

11.4 Sections 5.4 and 7.0 of this Agreement survive the termination or expiration of this Agreement until reporting obligations are completed.

12.0 Notice

12.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter, email, postage or other charges prepaid. Any communication that is delivered will be deemed to have been received in delivery; and, except in periods of postal disruption, any communication mailed by post will be deemed to have been received eight calendar days after being mailed.

The address of the Designated Official for Canada shall be:

Assistant Deputy Minister, Strategic Policy Branch
Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9

Email: jocelyne.voisin@hc-sc.gc.ca

The address of the Designated Official for Prince Edward Island shall be:

Assistant Deputy Minister, Community Health and Policy Branch
Department of Health and Wellness
P.O. Box 2000
Charlottetown, PE
Canada C1A 7N8

Email: MDBRADLEY@gov.pe.ca

13.0 General

13.1 This Agreement, including Annexes, comprises the entire Agreement entered into by the Parties.

13.2 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and Prince Edward Island.

13.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Prince Edward Island shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.

13.4 If for any reason a provision of this Agreement, that is not a fundamental term, is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be severed and deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

13.5 This Agreement may be executed in counterparts, in which case (i) the counterparts together shall constitute one agreement, and (ii) communication of execution by fax transmission or emailed in PDF shall constitute good delivery. Electronic signature(s) may be accepted as originals so long as the source of the transmission can be reasonably connected to the signatory.

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Canada by the Minister of Health at Ottawa, Canada this 15^th day of December, 2023.

The Honourable Mark Holland, Minister of Health

SIGNED on behalf of Canada by the Minister of Mental Health and Addictions and Associate Minister of Health at Toronto, Canada this 15^th day of December, 2023.

The Honourable Ya'ara Saks, Minister of Mental Health and Addictions and Associate Minister of Health

SIGNED on behalf of Prince Edward Island by the Minister of Health and Wellness at Charlottetown, Prince Edward Island this 15^th day of December, 2023.

The Honourable D. Mark V. McLane, Minister of Health and Wellness

Annex 1 – Common Statement of Principles on Shared Health Priorities

Common Statement of Principles on Shared Health Priorities

Annex 2 – Shared pan-Canadian interoperability roadmap

Figure 1. Text version below. — **Figure 1. 5-Year shared pan-Canadian interoperability**

Annex 3 – Headline common indicators


Shared health priority area	Indicator
Family health services	Percentage of Canadians who report having access to a regular family health team, a family doctor or nurse practitioner, including in rural and remote areas
Health workers and backlogs	Size of COVID-19 surgery backlog
Health workers and backlogs	Net new family physicians, nurses, and nurse practitioners
Mental health and substance use	Median wait times for community mental health and substance use services
	Percentage of youth aged 12 to 25 with access to integrated youth services (IYS) for mental health and substance use
	Percentage of Canadians with a mental disorder who have an unmet mental health care need
Modern health data system	Percentage of Canadians who can access their own comprehensive health record electronically
Modern health data system	Percentage of family health service providers and other health professionals (e.g., pharmacists, specialists, etc.) who can share patient health information electronically

Annex 4 – Action plan

Working Together to improve health care for Canadians three year action plan

This document describes Prince Edward Island's three-year action plan to support the development of a Share Health Priorities bilateral funding agreement. The initiatives identified in this action plan build upon ongoing efforts to modernize PEI's health care system and address the challenges impacting access to, and delivery of, health care services in the province and nationally. These initiatives align with healthcare system strategic plans and the Provincial Health Plan in development.

1.0 Summary of context and current healthcare system status

The new Shared Health Priorities agreement will focus on four areas: Family Health Teams; Health Workforce and Backlogs; Mental Health and Substance Use; and Modernizing Health Data Systems.

1.1 How are health services currently delivered in Prince Edward Island?

PEI's Health Services Act defines a range of health services that are delivered under the direction of the Minister of Health and Wellness. Overall, these services are delivered by Health PEI or the Department of Health and Wellness (the Department), or through provisions made by the Department.

Health PEI

Health PEI is responsible for the operation and delivery of publicly funded health services across the province. The principal areas for which Health PEI is responsible for the provision of service are:

Hospital-based Services
- Acute Care: Prince County Hospital and Queen Elizabeth Hospital provide a variety of services including but not limited to emergency, in-patient medical, surgical, pediatric, physical medicine, ambulatory, rehabilitative, palliative, and cancer care. Also, acute mental health services are provided at Hillsborough Hospital (see below).
- Community Hospitals: Community Hospital O'Leary, Kings County Memorial Hospital, Souris Hospital, and Western Community Hospital provide a variety of services including emergency, acute in-patient, ambulatory, convalescent/rehabilitative, palliative, and respite care.
- Diagnostic Imaging
- Laboratory
- Pharmacy Services
Mental Health and Addictions Services
- Acute Mental Health Services: provided at PCH, QEH, and Hillsborough Hospital (69-bed psychiatric hospital that provides specialized care, long-term treatment, and rehabilitation for individuals facing acute or enduring mental illness.)
- Addiction Services
- Community Mental Health
Primary Care and Community-Based Health Services
- Primary Care Clinics and Programs
- Chronic Disease Management
- Home Care, Palliative Care, and Geriatric Care
- Public Health and Children's Developmental Services Programs
- Provincial Dental Health Program
Long-term Care
- Health PEI Long-term Care through nine public nursing facilities
- Private Nursing Home Subsidies to 10 private long-term care facilities
Medical Programs
- In-Province and Out-of-Province

Department of Health and Wellness

In addition to general policy and operations, the Department ensures the provision of the following programs and services either through direct service delivery or through funding. The Department provides funding to several Non-Governmental Organizations (NGOs) to support their programs and operations.

Chief Public Health Office
- Environmental Health Inspection
- Communicable Disease Surveillance
- Population Health Assessment and Surveillance
- Health Promotion, Tobacco Cessation Program and other Harm Reduction Supports
- Public Health Emergency Management and Pandemic Preparedness
Community Health and Policy
- Community Care and Private Nursing Home Inspection
- Emergency Health Services
  - Ambulance Services for ground and air transport
  - Provisions for 811 Service
  - Provisions for Blood Services
  - Coordination of Organ and Tissue Donation and Transplantation
- Community Health Programs
  - Primary Care Roadmap and Renewal
  - Women and Gender Diverse People's Health
- Seniors Health
  - Infection Prevention and Control Program
  - Seniors Health Services Plan
  - COVID-19 Long-term Care Review
- Health Policy and Programs
Health Innovation
- Health Innovation Cluster
- Digital Health
- Strategic Initiatives
Mental Health and Addictions
- Health Workforce Planning and Pharmacy
  - Health Recruitment and Retention
  - Pharmaceutical Services
- Mobile Mental Health Teams
- Student Well-being Teams
- Gambling Addiction Support Line
- Provisions for the PEI Alliance for Mental Well-being

1.2 PEI health system priorities and alignment with shared health priorities

Prince Edward Island has identified four main priorities and 12 associated sub-priorities that it will pursue across the health system to improve healthcare delivery and ensure PEI residents achieve optimal health outcomes. At-a-glance, these priorities and sub-priorities are:

Priority 1
A Healthy and Sustainable Workforce	Capacity, Recruitment and Retention Supporting our Workforce Partnerships and Collaboration

Priority 2
Seamless Experience, Right Time, Right Place, Right Care	Seamless Access to Care Person Centred Care Coordinated Care

Priority 3
Equitable Access	Addressing Inequality Geographies of Interest Target Age Groups

Priority 4
Keeping our Island Healthy	Health and Wellness of All Residents Chronic Disease Prevention and Management Mental Health and Mental Wellness

The four health system priorities and associated sub-priorities align closely with the four Shared Health Priorities – Family Health Teams, Health Workforce and Backlogs, Mental Health and Substance Use, and Modernizing Health Data Systems. A brief overview of the alignment between Provincial health system priorities and the Shared Health Priorities follows here:

Family health teams (primary care)

Timely access to safe, quality healthcare is essential to the overall health of the population. To improve seamless access to care, the Department of Health and Wellness and Health PEI are focusing on actions that define the care continuum and ensure timely access to primary care services for all PEI residents. As well, PEI's population is growing and expanding in diversity. These changes create valuable opportunities for the Island and communities across the province to build on the rich culture of PEI. Government and service providers will work with communities and underserved populations in the planning, delivery, and evaluation of initiatives to address social inequities in healthcare. Strategies to address imbalances and improve patient control and autonomy over care are instrumental to ensuring health services are person-centred.

What we are doing:

Modernizing primary care in Prince Edward Island through implementation of the Primary Care Roadmap and the establishment of Patient Medical Homes and Patient Medical Neighbourhoods.
Continuing to build a foundation of care that is community-based and delivered through collaborative team-based care models to provide services closest to home for as long as possible.
Establishing program and collaborative practice models to support effective and efficient care coordination by both patients and providers.
Expanding mechanisms to promote communication and effective care coordination between programs across the healthcare system
Supporting our partners in care to implement mechanisms to ensure patients are engaged in the planning and delivery of their care.
Expanding initiatives that improve the experience for patients and families as they use and move through healthcare services.
Work with underserved communities, including Indigenous, LGBTQ+, rural, and racialized communities to address barriers and gaps in social and fiscal policy at the root cause of social inequities in health.

Health workforce and backlogs

A long-term plan for healthcare improvement requires a commitment to building a healthy and sustainable workforce. Core efforts to build resilience in the health workforce include building supply from domestic and international streams, expanding scopes of practice of care providers for system agility, using technology to streamline training and entry to practice, and creating healthy work environments that protect the health and wellness of our workforce. Also, Health PEI continues to address diagnostic backlogs in the health system prompted and exacerbated by the COVID-19 pandemic. Investments in provincial diagnostic imaging services, patient flow and system utilization, laboratory services, and expanding teams and hours of operation will contribute to a reduction in backlogs in the near term.

What we are doing:

Optimizing workforce capacity by expanding professional and employment scopes of practice and growing the health professions regulated to work in PEI.
Developing innovative solutions that streamline and integrate recruitment, hiring, and entry-to- practice processes for domestic and internationally trained health professionals.
Expanding training options that enable people to train on the job and build a more agile workforce.
Embedding cultural safety into our healthcare system through education and quality improvements.

Mental health and substance use

Mental health is more than just the absence of mental illness and includes a strong focus on mental well-being. Investing wisely in the overall mental health system, including early intervention, treatment, and recovery, can make a significant difference to the health of the population. To that end, initiatives are underway in PEI to create programs and social policy that address multiple risk factors and ease access to mental health and substance use services.

Although the Province of PEI does not intend to allocate Shared Health Priorities funding to this priority area in the 2023-24 to 2025-26 funding cycle, provincial and other funding (including funding through the 2017 Common Statement of Principles agreement) towards Mental Health and Substance use will continue to flow, and great strides are being made to establish a harm reduction site, establish additional mobile mental health units, and other mental health and addictions initiatives.

What we are doing:

Investing in infrastructure and programming to strengthen care for all ages and improve access to acute, community-based, and specialized mental health and substance use services.
Working with partners to implement initiatives focused on mental health and wellness promotion, early intervention, and reducing disparities for underserved and higher-risk populations.
Working across government to coordinate and provide targeted initiatives for improved access to services for higher-risk populations.

Modernization of health data systems

Innovative technological solutions can create meaningful change across the healthcare system, improving access to services and information for patients and providers. Advancing innovation through digital solutions like a province-wide Electronic Medical Record (EMR) solution will be a key enabler to support the health workforce and enable patients to better manage their own health through access to information.

Although the Province of PEI does not intend to allocate Shared Health Priorities funding to this priority area in the 2023-24 to 2025-26 funding cycles, provincial and other funding towards modernizing health data systems will continue to support initiatives in this area including implementing province wide EMR, increasing access to virtual care, and other digital health initiatives.

What we are doing:

Investing in virtual care and digital solutions to enable timely and seamless access to care.
Continuing to implement the EMR and other technological and digital initiatives and platforms to improve access to care and information for patients.
Implementing a digital health strategy that will guide the path forward for improved use of technology to achieve safe, quality, and efficient care.
Improving the appropriate collection and use of data to address factors that impact health inequities in PEI.
Maximizing advancements in technology and service delivery models to improve access and continuity of service for people living in rural areas, including establishing Island-wide access points for health cards and health program application through, for example, public libraries and Access PEI locations.

2.0 How will shared health priorities funding support PEI health system priorities and initiatives?

The Department of Health and Wellness has prioritized initiatives under the Family Health Teams and Health Workforce and Backlogs areas for the first three years of Shared Health Priorities funding in alignment with the province's upcoming Provincial Health Plan. Access to primary care, ongoing health human resource shortages, recruitment and retention challenges, and health workforce burnout and well-being are critical issues in Prince Edward Island, as they are nationally and globally.

As well, funding will continue to be invested in the Mental Health and Substance Use Shared Health Priority area through the existing 2017 Common Statement of Principles (2017 CSoP). Ongoing initiatives under the Mental Health and Substance Use priority area are described in this document and align closely with the primary care initiatives under the Family Health Teams priority area. Where possible, future builds of Community Health Centres will collocate primary care and mental health to further advance collaborative mental health in primary care.

Initiatives under the Family Health Teams and Health Workforce and Backlogs areas were deemed highest priority by senior leaders within the PEI healthcare system and decision-makers in the PEI Provincial Government. Public consultations have also identified these as high priority areas to focus investments on in the near-term. Several high-impact initiatives are currently underway under the identified priority areas that will benefit from the Federal funding provided through the Working Together to Improve Health Care for Canadians agreement.

The Federal funding assigned to initiatives under the Family Health Teams and Health Workforce and Backlogs priority areas builds on the provincial priorities identified in section 1.2. Shared Health Priorities funding will permit the province to accelerate and enhance the implementation of health initiatives for the benefit of PEI residents and healthcare providers. With the support of Federal funding, PEI can ensure that its Patient Medical Homes and Neighbourhoods are implemented sooner and Island- wide to help ease critical primary care access issues.

A summary review of the proposed funding allocation to initiatives under the Shared Health Priorities proceeds here, followed by a high-level description of each initiative.

2.1 3-year Shared Health Priorities and 2017 Common Statement Of Principles financial summary

Prince Edward Island's allocation of Shared Health Priorities funding and 2017 CSoP funding combined is $31.4 million per year ($28.8M Shared Health Priorities funding plus $2.6M 2017 CSoP funding), for a three-year total of $94.2 million.

Table 1 describes PEI's allocation of Shared Health Priorities and 2017 CSoP funding for the 2023-24, 2024-25, and 2025-26 fiscal years among several initiatives. The percentage of funds allocated to specific initiatives are estimates only, based on the understanding that actual amounts are subject to various internal and external factors and may require adjustments over time.

Table 1. Shared Health Priorities 3-year financial summary
Priorities and Initiatives	Incremental investments			Total
Priorities and Initiatives	2023-24	2024-25	2025-26	Total
Family health teams	$18,441,800	$21,459,800	$21,874,800	$61,776,400
Primary Care – patient medical homes	$12,861,800	$21,459,800	$21,874,800	$56,196,400
Primary Care – patient medical neighbourhoods
Primary Care - primary care access clinics
Supporting initiatives and programs for primary care and family health	$5,580,000	$0	$0	$5,580,000
Health workforce and backlogs	$10,358,200	$7,340,200	$6,925,200	$24,623,600
Recruitment – internationally educated Health professionals recruitment strategy	$3,121,500	$4,735,300	$4,735,300	$12,592,100
Recruitment – retaining, recruiting, and recognizing the credentials of health care Workers	$3,121,500	$4,735,300	$4,735,300	$12,592,100
Reducing backlogs in surgeries and Diagnostics	$7,236,700	$2,604,900	$2,189,900	$12,031,500
Mental health and substance use (2017 CSoP)	$2,600,000	$2,600,000	$2,600,000	$7,800,000
Mobile mental health	$2,600,000	$2,600,000	$2,600,000	$7,800,000
Student well-being teams	$2,600,000	$2,600,000	$2,600,000	$7,800,000
Grand total – all initiatives	$31,400,000	$31,400,000	$31,400,000	$94,200,000

The initiatives identified for Shared Health Priorities funding align closely with Federal Government priorities and PEI's Provincial Health Plan objectives. The initiatives funded through Shared Health Priorities and 2017 CSoP funding will advance primary care objectives, address critical health human resource challenges and backlogs exacerbated by the COVID-19 pandemic, and further PEI's commitment to enhancing services provided to underserved and vulnerable populations. Further information on each of the initiatives identified in Table 1 follows in the next section.

2.2 Family health teams initiatives

Shared Health Priorities funding will be allocated to initiatives that help ensure PEI residents have access to timely and effective primary care. The Department and Health PEI, in partnership with other government departments, health care providers, communities, and PEI residents, are implementing a multi-year Primary Care Roadmap to respond to immediate needs and transform the delivery of primary care in the province. The priority actions of this project are the establishment of Patient Medical Homes and Patient Medical Neighbourhoods.

Primary care – patient medical homes

Patient Medical Homes use a collaborative team-based approach to deliver patient-centred primary care services to PEI residents. Fourteen (14) Primary Medical Homes have been launched since March 2022 and are at various stages of development. The Shared Health Priorities funding allocated to this initiative will enable the establishment of up to 30 Patient Medical Homes across the province, each of which requires significant coordination and integration of capital and IT infrastructure, human resources, and change management processes. Patient Medical Homes established across PEI will enable residents without a family doctor, including many underserved and vulnerable PEI residents, access to primary care near their place of residence, easing pressure on emergency departments and walk-in clinics.

Unaffiliated PEI residents (i.e., any resident without a primary care provider) will be attached to a Patient Medical Home in their region. Patient Medical Homes will extend from tip-to-tip across PEI, providing primary care access to residents across PEI, particularly underserved people in rural areas, including PEI's two Indigenous communities, and recent immigrants and racialized PEI residents who often do not have access to a family physician.

Patient Medical Home teams address the needs of the local community by assessing these needs and offering the appropriate combination of services. Team composition will be tailored depending on the geographic location, population needs, and resources available, and will include physicians, nurse practitioners, dietitians, nurses, chronic disease educators, and other health professionals who work together with patients and their families to address health care needs.

Mental health and substance use services are included in the Patient Medical Home model through the inclusion of social workers and mental health therapists in the primary care team, highlighting PEI's commitment to enhancing mental health services across the province.

Patient Medical Homes are a core part of PEI's vision for transforming primary care health services from a current state of siloed practices and providers to a robust, team-based primary care model wherein every PEI resident and every family physician is part of a Patient Medical Home in a Patient Medical Neighbourhood.

Primary care – patient medical neighbourhoods

Patient Medical Neighbourhoods are a network of providers and services outside, but within accessible distance, of a Patient Medical Home. Each Patient Medical Home coordinates and integrates access to services within the Patient Medical Neighbourhood for the care of patients.

Each Patient Medical Neighbourhood will include a primary care network centred on the Patient Medical Home, with linkages to medical specialists and other community-based healthcare providers, hospitals, long-term care facilities, home care services, pharmacies, physiotherapists, occupational therapists, mental health and addictions supports and services, and community organizations and resources in the area near the central Patient Medical Home. Patient Medical Neighbourhoods are not tied to a physical location like the Patient Medical Home. Therefore, the suite of services within a Patient Medical Neighboorhood may serve multiple Patient Medical Homes. The Patient Medical Home acts as a navigational resource to ensure patients are linked with appropriate complementary providers and services in the community.

The Department and Health PEI have developed a framework for Patient Medical Neighbourhoods, and have been conducting engagement activities with government, providers, provider associations and colleges, and community partners to plan out the implementation of the first Patient Medical Neighbourhoods. Shared Health Priorities funding will enable the roll-out of the Patient Medical Neighbourhood model across all the Patient Medical Homes established in PEI. Specifically, funds assigned to Patient Medical Neighbourhoods will be used to enhance staffing, implement a PMN resource database for Patient Medical Homes and patients, establish Community Liaison staff in five health regions to help connect patients between services, and leverage technology and innovation opportunities through existing Access PEI and Public Library sites to improve patient access.

Primary care – primary care access clinics

Primary Care Access Clinics are a short-term measure to provide primary care services to people without a primary care provider. PEI residents without a primary care provider are currently provided free access to virtual care. When a virtual care visit is deemed not appropriate, patients are referred to an in-person visit at one of two Primary Care Access Clinics in PEI, located in Charlottetown and Summerside.

Between September 2022 and June 2023, there have been 3,392 patient visits to the Charlottetown Primary Care Access Clinic, and 1,310 to the Summerside Primary Care Access Clinic. Monthly clinic visits have been increasing over time, from 50 in September 2022 to 700 in June 2023. Based on these trends it is expected that visits will continue to increase, necessitating funding for both clinics during 2023-2024 while Patient Medical Homes and Neighbourhoods are being established. Shared Health Priorities funding will ensure staffing is stabilized at the Primary Care Access Clinics with the ability to expand as needed in 2023-2024. It is anticipated that Primary Care Access Clinics will be scaled back in 2024-2025 and 2025-2026 as more Patient Medical Homes are staffed and operating, and no federal funding has been assigned to the initiative in those years.

Supporting initiatives and programs for primary care and family health

Remaining funds will be allocated to other initiatives and programs to support primary care and chronic disease management, the establishment of Patient Medical Homes and Neighbourhoods, and family health through enhanced pharmacy and public health support. Included among these initiatives and programs are:

Overhead supports:
- Modernized agreements with private primary care clinics to ensure staffing and equipment supports are appropriate for these facilities,
Quality and safety, infection control, mentorship support for new graduate nurses:
- Enhance continuity of care and IPAC resources in community care and other health facilities, and
- Mentor new graduates in primary care, patient medical homes, and other facilities,
Primary care staffing and pharmacy support:
- In-province physician salaries, pharmacy services including a drug access navigator and community-based pharmacy healthcare services
Public and family health support through increased dental coverage for seniors and low-income residents:
- Enhance continuity of care, access to care, and prevention of future health issues.

Outcomes under the Patient Medical Homes and Neighbourhoods model, and interim transformation services provided through Primary Care Access Clinics, are manifold and impact patients, caregivers, healthcare providers, and population health. Team-based primary care improves the work-life of providers through improved job satisfaction, opportunity to work to full scope of practice, extending scope of practice by learning from other providers, sustainability in workload, and decreased professional isolation. Patient and caregiver experience is improved by offering patients timely access to primary care team members, primary care access closer to home, connection and access to specialty services, integration and coordination of services between providers and communities, and focused attention to other issues that impact health, such as the social determinants of health. Population health is improved by more appropriate utilization of resources, appropriate follow-up after discharge from acute care and transitions in care, and through chronic disease prevention and management programs. Finally, a robust team-based primary care model can enable cost-effective health care through reduced emergency department visits, enhanced coordination and integration of programs and services along the continuum of care, enhanced continuity of care, fewer adverse events, and improved recruitment and retention of healthcare providers.

2.3 Health workforce and backlogs initiatives

PEI, like many other jurisdictions in Canada and globally, is experiencing a critical shortage of healthcare workers and high worker burnout rates. Shared Health Priorities funding will be allocated to various initiatives to recruit and retain healthcare workers to promote an effective and sustainable healthcare system.

Internationally educated health professionals strategic plan

PEI will develop and implement a strategic plan to recruit internationally educated health professionals to the province. This plan will aim to reduce financial, socio-cultural, and professional barriers that inhibit internationally educated health professionals from immigrating to and working within their profession in PEI.

Addressing health human resource issues in PEI and nationally will require strategic and coordinated efforts to recruit trained health care professionals from abroad ethically and fairly, understanding that health care professional shortages are a global phenomenon. PEI supports principles of ethical recruitment of health personnel, considering the rights, obligations and expectations of source countries, destination countries, and migrant health personnel. In the last year, PEI has embarked on health recruitment missions in Dubai, UAE, and London, England, and works closely with the PEI Office of Immigration to fill health care vacancies with skilled international talent.

Funding for this initiative will support a dedicated staffing position to ensure that the province can develop an Internationally Educated Health Professionals Strategic Plan in the first year of funding. Funding in years two and three will ensure strategic plan actions can be implemented to bolster IEHP recruitment and hiring in PEI.

We need to ensure health services meet the needs of the increasingly diverse population of PEI. Ensuring procedures are in place to reduce barriers to immigration and which permit Internationally Educated Health Professionals to practice more readily in PEI will lead to multiple positive outcomes – not only easing health human resource pressures, but also reducing disparities among the healthcare workforce and meeting the language and cultural needs of patients from different ethnic backgrounds. Initiatives under this heading will include reducing impediments to credential recognition and streamlining hiring processes to get Internationally Educated Health Professionals into the field faster. Investments in the recruitment and retention of Internationally Educated Health Professionals will complement ongoing provincial initiatives to promote diversity and create welcoming work and living environments for women and gender diverse Islanders and aligns well with the Department of Health and Wellness' Health Strategy for Women and Islanders Who Are Gender Diverse 2022-2027.

Retaining, recruiting, and recognizing the credentials of health care workers

Shared Health Priorities funding under this initiative will be allocated to Health PEI objectives that bolster recruitment, retention, and recognition of health care workers in PEI. Specific objectives include:

Enhancing human resources through additional:
- Supports for employee health, nursing, and labour relations, and
- Funding for leadership and talent management.
Enhancing retention of health care staff through:
- Improved organizational safety and compliance, and
- Funding for scheduling systems, operational supports, and help desk.
Enhancing recruitment of health care staff through:
- Creation of a job guarantee program for students studying in health care fields to guarantee full-time positions upon graduation.

Planning for these initiatives is in the preliminary stages. More information on specific actions will be communicated by the Department of Health and Wellness and Health PEI as details become available.

Reducing backlogs in surgeries and diagnostics

Shared Health Priorities funding under this initiative will be allocated to Health PEI programs and services that will make headway on surgical and diagnostics backlogs that arose or were exacerbated by the COVID-19 pandemic. Specifically, funding will be directed to increasing hours of operation and human resource support in diagnostic imaging, anesthesiology and radiology, CT technology and ultrasound technology, general surgery, ophthalmology, and laboratory services to increase patient throughput and reduce wait times.

2.4 Mental health and substance use initiatives

The Department established a new Mental Health and Addictions division in 2021, aiming to improve access to mental health and addictions services for PEI residents by ensuring activities are coordinated across various departments and stakeholders. Considerable work has occurred since the establishment of the division to improve and enhance mental health and addictions services, including implementing actions from the Mental Health and Addictions Strategy and the Suicide Prevention Strategy, establishing the Mobile Mental Health Response Service, and initiating a Mental Health and Addictions capital redevelopment project. Some of the strides that have been made in PEI to improve access to Mental Health and Substance Use programs and resources with Common Statement of Principles funding and provincial funding include:

Opening four new walk-in mental health clinics – three in western PEI and one in eastern PEI – providing coverage across the province,
Implementation of Seniors Mental Health Resource teams in rural areas,
Implementation of Student Well-being teams in families of schools across PEI,
Improved access to gender-confirming surgical procedures and non-surgical treatments for transgender Islanders,
Increased support for the Strength Program, providing residential and day treatment programming and supports for youth aged 15-24, and their families,
Investment of $100 million in modernized mental health and addictions facilities and infrastructure,
Engagement with public libraries to provide Mental Health and Gambling Support Kits to help educate individuals and support those seeking self-care,
Ongoing Wellness Grants to communities and organizations for wellness initiatives that promote healthy living,
Implementation of an online mental health program to help PEI residents connect to mental health and substance use services,
New mental health supports for PEI farmers and fishers through the Farmers Talk Program and the Fisher Assistance Program,
Implementation of a new mental health and addictions single point of access phone line,
Establishment of a new Mental Health and Addictions Research Centre at Health PEI,
Implementation of the Mobile Mental Health Response Service in 2021, providing Island-wide support to individuals who may be experiencing a mental health crisis,
Implementation of the Anti-Racism Microgrants funding initiatives in 2022, providing small grants to organizations and individuals in various fields to create community-led projects, workshops, and training events addressing racism,
Development of Awareness to Action: A Health Strategy for Women and Islanders Who Are Gender Diverse 2022-2027, which describes priority areas and actions to improve the health and well-being, including mental health and mental well-being, of women and gender diverse people at every stage of their lives,
Implementation of a new online mental health support program for public safety partners including firefighters, search and rescue volunteers, paramedics, policy officers, and public safety communicators,
Opening of a new Addictions Extended Care facility to support Island women recovering from substance use,
Implementation of a new day program for acute mental health patients, and
Construction initiated on a dedicated Mental Health and Addictions Emergency and Short Stay Unit, the first-of-its kind in Atlantic Canada.

Existing 2017 Common Statement of Principles funding earmarked for Mental Health and Substance Use initiatives will continue through the 2023-24, 2024-25, and 2025-26 fiscal years under two key initiatives: Mobile Mental Health and Student Well-being Teams. Funding to these two programs will ensure the Mobile Mental Health Response Service and Student Well-being Teams are appropriately staffed and have access to tools and resources to provide mental health and addictions services close to where people needing the services live and go to school. Mobile Mental Health and Student Well-being teams ensure that PEI residents living in rural areas, within Indigenous communities, and in underserved and vulnerable populations have access to mental health and mental wellness supports when and where needed.

Mobile mental health

The Mobile Mental Health Response Service provides rapid patient assessment and support to people in communities from an integrated team of specialists including healthcare professionals, police services, and emergency medical services. Mobile Mental Health units are coordinated by the Department of Health and Wellness, with operational management through Medavie Health Services – a private company that also operates PEI's emergency medical service, Island EMS.

Mobile Mental Health units have the tools and systems in place to ensure that if a situation changes from crisis to emergency, the appropriate supports can be dispatched safely and effectively. Mobile Mental Health units are in place to ensure mental health services are available close to where people live, and to ease pressure on emergency departments and the 911 system for mental health and addictions related issues. Funding through the 2017 CSoP will allow for a permanent staffing complement for Mobile Mental Health units through the next four years of the agreement.

PEI's Mobile Mental Health Response Service has fielded almost 7,000 calls since its inception in October 2021. Eighty-eight percent (88%) of those calls have been mitigated over the phone by trained clinicians, with the remainder mitigated by field teams in the community. Continued funding will ensure this vital service continues to provide 24/7 access to trained mental health clinicians.

Student well-being teams

Student well-being teams work in PEI public schools advising, consulting, and providing direct service to children and youth who are struggling with mental, social, and physical health issues. When professionals are in schools, children have timely access to supports to help them succeed in school and throughout life. Reducing barriers like transportation brings services to students to support their well- being.

Student Well-being Teams are currently staffed and resourced to provide services Island-wide to over 21,000 students in 56 English public schools and 6 French public schools. Funding through the 2017 CSoP will allow for a permanent staffing complement for Student Well-being Teams through the next four years of the agreement.

3.0 Advancement of Indigenous health priorities

The initiatives supported by Shared Health Priorities funding will have broad impacts that affect all PEI residents. However, the Department of Health and Wellness and Health PEI are committed to working with Indigenous partners across the province to contribute to positive health outcomes for members of the Abegweit First Nation, the Lennox Island First Nation, and other Indigenous organizations in PEI.

The two Mi'kmaq communities in PEI – Abegweit and Lennox Island – have their own strategic plans and priorities regarding the delivery of healthcare services in and around their communities. While there are many ways in which the strategic health plans of Abegweit and Lennox Island align with each other and with the Shared Health Priorities identified in this 3-year action plan, they are distinct and specific to each community. It will be critical for the Department of Health and Wellness and Health PEI to maintain ongoing, consistent, and meaningful discussions with both communities to determine how Shared Health Priorities initiatives and other provincial programming can better support Indigenous health. The Department of Health and Wellness has committed to establishing an Indigenous health engagement committee to continue ongoing discussions with the Abegweit and Lennox Island First Nations, ensuring PEI's two Mi'kmaq communities have a say in the way health policy is established and implemented in PEI.

These conversations and discussions have been initiated with Abegweit First Nation and Lennox Island First Nation, and further opportunities for mutually beneficial partnerships and collaboration will be explored during this 3-year action plan and beyond. The Department of Health and Wellness views the establishment of Patient Medical Homes and Patient Medical Neighbourhoods as initiatives that can have a significant impact on primary care access for people living in First Nation.

4.0 Measuring and reporting on initiatives supported by Shared Health Priorities funding in 2023-24 to 2025-26

In addition to the eight common indicators developed by the Canadian Institute for Health Information (CIHI) in collaboration with Federal, Provincial, and Territorial governments and other key health data partners, the province has identified nine additional indicators related to the initiatives funded through the Shared Health Priorities funding. These indicators complement but do not overlap with the eight common indicators compiled by CIHI. Tables 2 and 3 outline the provincial and national common indicators, respectively.

Table 2. Provincial indicators, targets, and timeframes
Indicators	Baseline	Target	Timeline
Family health teams
# of patient medical homes (PMHS)	14	Up to 30	March 2026
Number of physicians/NPS/allied health enrolled in PMHS	75	200	March 2026
Number of primary care access clinic visits (monthly)	700	0^{Footnote a}	March 2026
Health workforce and backlogs
# of internationally educated health professionals hired	-^{Footnote b}	-^{Footnote b}	-^{Footnote b}
Average time-to-fill for health PEI vacancies (internal hires)	36 days	32	March 2026
Average time-to-fill for health PEI vacancies (external hires)	54 days	32	March 2026
Mental health and substance use (2017 CSOP)
Number of clients seen by mobile mental health (annual)^{Footnote c}	2500	5000	March 2026
% of visits to the er with mental health and/or substance use concerns (annual)	8.3%^{Footnote d}	8.3%^{Footnote d}	March 2026
a Primary Care Access Clinics are considered a temporary measure in place during the establishment of Patient Medical Homes and Patient Medical Neighbourhoods. Ideally, as more unaffiliated patients are assigned to Patient Medical Homes, visits to Primary Care Access Clinics will continue to decrease. Return to footnote a referrer b Data are not currently available on the number of Internationally Educated Health Professionals hired. This indicator will be updated as data become available. Return to footnote b referrer c Includes number of telehealth clinical interventions and number of mobile dispatches by the mobile mental health service. Return to footnote c referrer d Three-year average (2020/21 to 2022/23) of visits to Queen Elizabeth Hospital and Prince County Hospital ER with mental health and/or substance use concerns. PEI's aim is to maintain this level considering rapidly increasing population growth within the province. Return to footnote d referrer

Table 3. National Common Indicators, Targets, and Timeframes (CIHI)
Indicators	Baseline	Target	Timeline
Family health teams
% of PEI residents who report having access to a regular family health team, a family doctor, or nurse practitioner, including in rural and remote areas	81%	100%	March 2026
Health workforce and backlogs
Size of COVID-19 surgery backlog	0%	0%	Complete
Supply of family physicians, nurses, and nurse practitioners per 10,000 population
Family physicians	11	11^{Footnote a}	March 2026
Registered nurses	106	106^{Footnote a}	March 2026
Nurse practitioners	4	4^{Footnote a}	March 2026
Mental health and substance use
Integrated youth services availability	N/A^{Footnote b}
% of PEI residents aged 12 and over who report a diagnosed mood or anxiety disorder and needs for mental health care not met	7%	7%^{Footnote c}	March 2026
Wait times for community mental health counselling	-^{Footnote d}	-^{Footnote d}	-^{Footnote d}
Modernized health data systems
% of PEI residents who have accessed their personal health information electronically at any time	N/A^{Footnote e}
% of PEI physicians who exchange patient clinical summaries with doctors outside their practice	N/A^{Footnote e}
a PEI's aim is to maintain the overall supply of family physicians, registered nurses, and nurse practitioners per 10,000 population, considering rapid population growth in the province. Return to footnote a referrer b PEI is not using federal funding from this action plan for Mental Health and Substance Use initiatives beyond those identified for existing 2017 Common Statement of Principles funding. However, provincial funding will continue to be invested in developing Integrated Youth Services in the province. Return to footnote b referrer c PEI's aim is to maintain the current percentage considering rapid population growth in the province. Return to footnote c referrer d Data are not currently available on wait times for community mental health counselling. This indicator will be updated as data become available. Return to footnote d referrer e PEI is not using federal funding from this action plan for Modernizing Health Data Systems. However, provincial funding will continue to be invested in initiatives under this category. Return to footnote e referrer

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Date modified:: 2024-06-12