Canada-New Brunswick Home and Community Care and Mental Health and Addictions Services Funding Agreement

BETWEEN:

HER MAJESTY THE QUEEN IN RIGHT OF CANADA (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health (herein referred to as "the federal Minister")

- and -

HER MAJESTY THE QUEEN IN RIGHT OF THE PROVINCE OF NEW BRUNSWICK (hereinafter referred to as "New Brunswick" or "Government of New Brunswick") as represented by the Minister of Health herein referred to as "the provincial Minister")

REFERRED to collectively as the "Parties"

PREAMBLE

WHEREAS, on December 22, 2016 Canada and New Brunswick agreed to targeted federal funding over 10 years, beginning in 2017-18, for investments in home and community care and mental health and addictions, in addition to the existing legislated commitments through the Canada Health Transfer;

WHEREAS, Canada and New Brunswick agreed to a Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the Common Statement, attached hereto as Annex 1) on August 21, 2017,which articulated their shared vision to improve access to home and community care as well as mental health and addictions services in Canada;

WHEREAS, Canada authorizes the federal Minister to enter into agreements with the provinces and territories, for the purpose of identifying activities provinces and territories will undertake in home and community care and mental health and addictions services, based on a menu of common areas of action and in keeping with the performance measurement and reporting commitments, consistent with the Common Statement;

WHEREAS Canada and the New Brunswick agree that data collection and public reporting of outcomes is key to reporting results to Canadians on these health system priorities, and that the performance measurement approach taken will recognize and seek to address differences in access to data and health information infrastructure;

WHEREAS, theRegional Health Authorities Act (R.S.N.B. 2011, c. 217)authorizes 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 New Brunswick for the provision of health services which includes  home and community care and mental health and addictions initiatives;

WHEREAS, New Brunswick makes ongoing investments in home and community care and mental health and addictions services, consistent with its broader responsibilities for delivering health care services to its residents;

AND WHEREAS the Government of Canada makes ongoing investments in home and community care and mental health and addictions services for Indigenous communities and other federal populations.

NOW THEREFORE, Canada and New Brunswick agree as follows:

1.0 Objectives

1.1 Building on New Brunswick's existing investments and initiatives, Canada and New Brunswick commit to work together to improve access to home and community care and strengthen access to mental health and addictions services (listed in the Common Statement, attached as Annex 1).

2.0 Action Plan

2.1 New Brunswick will invest federal funding provided through this Agreement in alignment with the selected action(s) from each menu of actions listed under home and community care and mental health and addictions in the Common Statement.

2.2 New Brunswick's approach to achieving home and community care and mental health and addictions services objectives is set out in their five-year Action Plan (2017-18 to 2021-22), as set out in Annex 2.

3.0 Term of Agreement

3.1 The term of this agreement is four years, from April 1, 2018 to March 31, 2022 (the Term).

3.2 Renewal of Bilateral Agreement

3.2.1 New Brunswick's share of the federal funding for 2022-23 to 2026-27, based on the federal commitment in Budget 2017 of $11 billion over ten years, will be provided upon the renewal of bilateral agreements, subject to appropriation by Parliament, and New Brunswick and Canada's agreement on a new five-year action plan.

3.2.2 The renewal will provide New Brunswick and Canada the opportunity to review and course correct, if required, and realign new priorities in future bilateral agreements based on progress made to date.

4.0 Financial Provisions

4.1 The contributions made under this Agreement are in addition and not in lieu of those that Canada currently provides to New Brunswick under the Canada Health Transfer to support delivering health care services within their jurisdiction.

4.2 Allocation to New Brunswick

4.2.1 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.

4.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative on a per capita basis for the Term starting on April 1, 2018 and ending on March 31, 2022.

Home and Community Care

  1. $600 million for the Fiscal Year beginning on April 1, 2018
  2. $650 million for the Fiscal Year beginning on April 1, 2019
  3. $650 million for the Fiscal Year beginning on April 1, 2020
  4. $900 million for the Fiscal Year beginning on April 1, 2021

Mental Health and Addictions Services

  1. $250 million for the Fiscal Year beginning on April 1, 2018
  2. $450 million for the Fiscal Year beginning on April 1, 2019
  3. $600 million for the Fiscal Year beginning on April 1, 2020
  4. $600 million for the Fiscal Year beginning on April 1, 2021

4.2.3 Annual funding will be allocated to provinces and territories on a per capita basis, for each fiscal year that an agreement is in place. The per capita funding amounts for home and community care and for mental health and addictions services, for each fiscal year, are calculated using the following formula: F x K/L, where:

  • F is the annual total funding amount available under this program (funding amount will change depending on fiscal year);
  • K is the total population of the particular province or territory, as determined using annual population estimates from Statistics Canada; and
  • L is the total population of Canada, as determined using annual population estimates from Statistics Canada.

4.2.4 For the purposes of the formula in section 4.2.3, the population of New Brunswick for each fiscal year and the total population of all provinces and territories for that Fiscal Year are the respective populations as determined on the basis of the quarterly preliminary estimates of the respective populations on July 1 of that Fiscal Year. These estimates are released by Statistics Canada in September of each Fiscal Year.

4.2.5 Subject to annual adjustment based on the formula described in section 4.2.3, New Brunswick's estimated share of the amounts will be:

Fiscal Year Home and community care
Estimated amount to be paid to New BrunswickFootnote * (subject to annual adjustment)
Mental health and addictions services
Estimated amount to be paid to New BrunswickFootnote * (subject to annual adjustment)

Footnotes

Footnote *

Amounts represent annual estimates based on [Census 2017 population]

Return to footnote * referrer

2018-2019 $12,420,000 $5,170,000
2019-2020 $13,450,000 $9,310,000
2020-2021 $13,450,000 $12,420,000
2021-2022 $18,630,000 $12,420,000

4.3 Payment

4.3.1 Canada's contribution will be paid in approximately equal semi-annual installments as follows:

  1. The first installment will be paid on or about April 15 of each Fiscal Year. The second installment will be paid on or about November 15 of each Fiscal Year.
  2. The amount of the first installment will be equal to 50% of the notional amount set out in Article 4.2.5 as adjusted by Article 4.2.3.
  3. The amount of the second installment will be equal to the balance of Canada's contribution to New Brunswick for the Fiscal Year as determined under sections 4.2.5 and 4.2.3.
  4. Canada will notify New Brunswick at the beginning of the 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.  Canada will notify New Brunswick of the actual amount of the second installment in each Fiscal year as determined under the formula set out in sections 4.2.5 and 4.2.3.
  5. Canada shall withhold payment of the second installment for the Fiscal Year if New Brunswick has failed to provide its annual financial statement for the previous Fiscal Year or to provide data and information related to home and community care and mental health and addictions to CIHI for the previous Fiscal Year in accordance with section 5.1.2
  6. The sum of both semi-annual installments constitutes a final payment and is not subject to any further adjustment once the second installment of that Fiscal Year has been paid.
  7. Payment of Canada's funding for each Fiscal Year of this Agreement is subject to an annual appropriation by Parliament of Canada for this purpose.

4.4 Carry Over

4.4.1 At the request of New Brunswick, New Brunswick may retain and carry forward to the next Fiscal Year, not beyond March 31, 2022, the amount of up to 10 per cent of the contribution paid to New Brunswick for a Fiscal Year under subsection 4.2.5. that is in excess of the amount of the eligible costs actually incurred by New Brunswick in that Fiscal Year, and use the amount carried forward for expenditures on eligible areas of investment incurred in that Fiscal Year.  Any request by New Brunswick to retain and carry forward an amount exceeding 10 per cent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters.

4.4.2 For greater certainty, any amount carried forward from one Fiscal Year to the next under this subsection is supplementary to the maximum amount payable to New Brunswick under subsection 4.2.5. of this Agreement in the next Fiscal Year.

4.4.3 All amounts carried forward, pursuant to section 4.4.1 must be spent by March 31, 2022. New Brunswick is not entitled to retain any such carried forward amounts that remain unexpended after March 31, 2022, nor is it entitled to retain any balance of Canada's contribution for Fiscal Year 2021-22 paid pursuant to subsection 4.2.5 that remains unexpended at the end of that Fiscal Year. Such amounts are to be repaid to Canada in accordance with section 4.5.

4.5 Repayment of overpayment

4.5.1 In the event payments made to New Brunswick exceed the amount to which New Brunswick 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, New Brunswick shall repay the amount within sixty (60) calendar days of written notice from Canada.

4.6 Use of Funds

4.6.1 Canada and New Brunswick agree that funds provided under this Agreement will only be used by New Brunswick in accordance with the areas of action outlined in Annex 2.

4.7 Eligible Expenditures

4.7.1 Eligible expenditures for funds provided under this Agreement are the following:

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

5.0 Performance Measurement and Reporting to Canadians

5.1 Funding conditions and reporting

5.1.1 As a condition of receiving annual federal funding, New Brunswick agrees to participate in a Federal-Provincial-Territorial process, including working with stakeholders and experts, through the Canadian Institute for Health Information (CIHI), to develop common indicators and to share relevant data in order to permit CIHI to produce annual public reports that will measure pan-Canadian progress on home and community care and mental health and addictions services.

  1. New Brunswick will designate an official or official(s), for the duration of this agreement, to work with CIHI and represent the interests of New Brunswick related to performance measurement and reporting for home and community care, as well as mental health and addictions services.

5.1.2 As a condition of receiving annual federal funding, by no later than October 1 of each Fiscal Year during the Term of this Agreement, New Brunswick agrees to:

  1. Provide data and information (based on existing and new indicators) related to home and community care and mental health and addictions services to the Canadian Institute for Health Information annually. This will support the Canadian Institute for Health Information to measure progress on the shared commitments outlined in the Common Statementand report to the public.
  2. Provide to Canada an annual financial statement, with attestation from the province's Chief Financial Officer, of funding received from Canada under this Agreement during the Fiscal Year compared against the action plan, and noting any variances, between actual expenditures and New Brunswick's Action Plan (Annex 2):
    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 home and community care and mental health and addictions programs and services;
    3. If applicable, the amount of any amount carried forward by New Brunswick under section 4.4; and
    4. If applicable, the amount of any surplus funds that is to be repaid to Canada under section 4.5.

5.2 Audit

5.2.1 New Brunswick will ensure that expenditure information presented in the annual financial statement is, in accordance with New Brunswick's standard accounting practices, complete and accurate.

5.3 Evaluation

5.3.1 Responsibility for evaluation of programs rests with New Brunswick in accordance with its own evaluation policies and practices.

6.0 Communications

6.1 Canada and New Brunswick 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.

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

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

6.4 Canada, with prior notice to New Brunswick, may incorporate all or any part or parts of the data and information in 5.1.2, or any parts of evaluation and audit reports made public by New Brunswick 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.

6.5 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and bilateral agreements. Canada agrees to give New Brunswick 10 days advance notice and advance copies of public communications related to the Common Statement, bilateral agreements, and results of the investments of this Agreement.

6.6 New Brunswick reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and bilateral agreements. New Brunswick agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, bilateral agreements, and results of the investments of this Agreement.

7.0 Dispute Resolution

7.1 Canada and New Brunswick 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.

7.2 If at any time either Canada or New Brunswick 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, Canada or New Brunswick, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and New Brunswick will endeavour to resolve the issue in dispute bilaterally through their designated officials, at the Assistant Deputy Minister level (hereinafter the "Designated Officials").

7.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada and New Brunswick responsible for health, and if it cannot be resolved by them, then the respective Ministers of Canada and New Brunswick most responsible for Health shall endeavour to resolve the dispute.

8.0 Amendments to the Agreement

8.1 The main text of this Agreement (not including attached annexes) may be amended at any time by mutual consent of the Parties. To be valid, any amendments shall be in writing and, signed, in the case of Canada, by Canada's Minister of Health, and in the case of New Brunswick, by New Brunswick's Minister of Health.

8.2 Annex 2 may be amended at any time by mutual consent of the Parties. To be valid, any amendments to Annex 2 shall be in writing and, signed, in the case of Canada, by their Designated Official, and in the case of New Brunswick, by their Designated Official.

9.0 Equality of Treatment

9.1 During the term of this Agreement, if another province or territory, except the province of Quebec, negotiates and enters into a Home and Community Care and Mental Health and Addictions Services Agreement with Canada, or negotiates and enters into an amendment to such an agreement and if, in the reasonable opinion of New Brunswick, any provision of that agreement or amended agreement is more favourable to that province or territory than the terms set forth in this Agreement, Canada agrees to amend this Agreement in order to afford similar treatment to New Brunswick, if requested by New Brunswick. This includes any provision of the bilateral agreement except for the Financial Provisions set out under section 4.0. This amendment shall be retroactive to the date on which the Home and Community Care and Mental Health and Addictions Services Agreement or the amendment to such an agreement with the other province or territory, as the case may be, comes into force.

10 Termination

10.1 Canada may terminate this Agreement at any time if the terms of this Agreement are not respected by New Brunswick by giving at least 12 months written notice of its intention to terminate. New Brunswick may terminate this Agreement at any time if the terms of this Agreement are not respected by Canada by giving at least 12 months written notice of its intention to terminate.

10.2 As of the effective date of termination of this Agreement under section 10.1, Canada shall have no obligation to make any further payments to New Brunswick after the date of effective termination.

11 Notice

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

The address for notice or communication to Canada shall be:

Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9

Email: marcel.saulnier@canada.ca

The address for notice or communication to New Brunswick shall be:

New Brunswick Department of Health
HBSC Place
P.O. Box 5100
Fredericton, New Brunswick
E3B 5G8

Email: mark.wies@gnb.ca

12.0 General

12.1 This Agreement, including Annexes 1 and 2, comprise the entire agreement entered into by the Parties with respect to the subject matter hereof.

12.2 This Agreement is based on the Common Statement of Principles on Shared Health Priorities, Annex 1, finalized on August 21, 2017.

12.3 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and New Brunswick.

12.4 No member of the House of Commons or of the Senate of Canada or of the Legislature of New Brunswick shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.

12.5 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 deemed to be severable and will be deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

SIGNED on behalf of Canada by the Minister of Health at Fredericton, New Brunswick this 15th day of December, 2017.

The Honourable Ginette Petitpas Taylor, Minister of Health

SIGNED on behalf of New Brunswick by the Minister of Health at Fredericton, New Brunswick  this 15th day of December, 2017.

The Honourable Benoît Bourque, Minister of Health

Annex 1 to the Agreement

Common Statement of Principles on Shared Health Priorities

Annex 2 to the Agreement

New Brunswick Action Plan on Home and Community Care and Mental Health and Addictions Services

Introduction

A number of initiatives have been launched in New Brunswick during the last decade to help decrease the incidence of chronic disease, increase access to universal health care and improve overall well-being, including mental fitness and resilience. In January 2017, the New Brunswick Government announced a new framework and stakeholder engagement process to develop the New Brunswick Family Plan. Through a series of summits across the province, stakeholder groups got involved in the process to develop the New Brunswick Family Plan that will support families and build a stronger, healthier province.

The New Brunswick Family Plan addresses the factors that have the greatest impact on our health and well-being. It is the foundation to establish an integrated system of health and social care that provides appropriate health and social supports to help those in need to lead independent, healthy and productive lives.

The New Brunswick Family Plan focuses government action in seven priority areas: improving access to primary and acute care; promoting wellness; supporting people with addictions and mental health challenges; fostering healthy aging and support for seniors; advancing women’s equality; reducing poverty; and supporting people with disabilities.

This Action Plan focuses on two priority areas (home and community care and mental health and addictions) where federal funding will be provided to New Brunswick to enhance, expand or accelerate the provincial priorities and investments in the New Brunswick Family Plan. It aligns with the objectives of the Common Statement of Principles on Shared Health Priorities. 

Home and Community Care

Overview

New Brunswick has the largest proportion of seniors in Canada and this percentage will increase in the coming years. While this is a challenge to the system, it is also an oppor­tunity to deliver more effective and sustainable long-term care services to improve the quality of life for all seniors in the province.

Seniors want to remain independent, preferably in their own home or community, and they need the proper support to do so. Access to a range of home supports and home health services, as well as specialized care options, will help seniors be more independent and better supported in managing chronic illness.

To better meet the needs of sen­iors, enhanced home support services and options for care in the community are needed. Access to these types of supports helps seniors maintain their health and independence through an integrated continuum of care that is more sustainable and targeted; one that considers various values, cultural backgrounds, religious beliefs, social circumstances and lifestyle choices. These objectives are also consistent with the objectives of the New Brunswick Family Plan pillar “improving access to primary and acute care”.

Home and Community Care in New Brunswick Today:

Primary health care is usually the first place people go when they have health concerns.  Primary health care is usually delivered in the community by a wide range of providers including family doctors, nurse practitioners, nurses, psychologists, physiotherapists, occupational therapists, pharmacists and other health providers.  Together, they are the critical hub of a comprehensive approach for patient centred, integrated care that can improve the efficiency of the health care system, health outcomes, patient satisfaction and quality of care. 

Primary health care services occur across the province in diverse locations such as physicians’ offices, community health centres, health service centres, community mental health centres, homes, as well as through an array of private services such as pharmacists and physiotherapy services.

As provincial governments aim to improve the efficiency and effectiveness of health care, evaluating primary health services is critical as these services touch the lives of virtually all New Brunswickers. Within a given year, over 90% of citizens receive some form of Primary Health Care service. Health care systems with a strong foundation on primary health are recognized for improving the overall health of populations and are also important in chronic disease prevention, control and management.

New Brunswick has been investing in the development of a wide network of primary health care services.  These services include: Community Health Centres; Health Services Centres; Addiction Services; Community Mental Health Centres; Public Health; and Extra Mural. In addition, all New Brunswickers have 24/7/365 access to Tele-Care 811 services or can access primary care through their family physician’s office.

The results of the 2014 Primary Health Care Survey conducted by the New Brunswick Health Council show 92% of New Brunswickers have a family physician. Only 18.2% of New Brunswickers reported that their family doctor has an after-hour arrangement when the office is closed, and only 30% can get an appointment with their family doctor on the same day or next day when sick or in need of care.

Evidence suggests that those who live in close proximity to the emergency department use it more frequently as a substitute for family physicians.  In areas with a shortage of general practitioners, unmet demands will inevitably be channeled to the emergency departments. Over 61% of the emergency department visits in New Brunswick are labeled as Triage level 4 and 5 visits. These visits are categorized as less urgent or non-urgent visits and could have been taken care of outside of the acute care system.

When patients visit an after-hours clinic or emergency department instead of going to the family physician, the providers are less likely to be aware of the patient’s health history including previous illnesses and treatment.  There may be a lack of continuity and follow-up that also makes it difficult to engage patient and provider in shared decision making.

The Department of Health introduced Patient Connect NB in May 2013 for citizens that do not have a health care provider or want to change providers. To date the program has worked on over 78,000 patient records:

  • 24,000 patients have been matched to a provider by the program;
  • 23,500 patients have been taken by a provider in the regional health authorities (new hires, replacements, increased community health center capacity); and
  • 22,000 patients are still waiting to be matched.

In addition to the access challenges outlined above, New Brunswick is facing considerable challenges related to an aging population as well as chronic conditions.

New Brunswick has the highest percentage of population over the age of 65 when compared to the rest of Canada (19% versus 16%). Over the last 60 years, New Brunswick has aged more rapidly than the rest of Canada and this trend is expected to continue (31% versus 24% in 2038).

The percentage of individuals affected by chronic disease in New Brunswick is expected to increase as a result of contributing risk factors, such as being overweight or obese, being physically inactive and smoking, as well as through population aging. The percentage of New Brunswickers with a chronic health condition has generally been higher than the Canadian average. This trend has had and will continue to have an impact on the health care system. Based on self-reported data, close to 65% of New Brunswickers have one or more chronic conditions. 

Chronic conditions are responsible for significant burden within the health care system.  Seniors are staying longer in acute care – in the 4-year period from 2011-12 to 2014-15, the average length of stay for seniors increased by 13% (from 12.7 days to 14.3 days). The key drivers of seniors’ length of stay and resource utilization in acute care are dementia, COPD, Palliative Care and Heart Failure.

The challenges outlined present a unique opportunity to enhance our community services so that we can ensure New Brunswickers can: stay in their own homes as long as possible; receive help with navigating the healthcare system; experience increased continuity of care; and receive the care and services they need at the right time and the right place.  

The New Brunswick Extra-Mural Program (EMP)

The EMP is the provincial home healthcare program that provides comprehensive healthcare services to New Brunswickers in their homes.  The EMP or “Hospital Without Walls” offers care-at-home services targeting the demographic trend towards an aging population and those with comorbidities requiring more extensive care. The program has the mandate to: provide an alternative to hospital admission; facilitate early discharge from hospitals; and provide an alternative to, or postponement of, admission to long-term care facilities (i.e. nursing homes).  Home healthcare services include: acute, palliative, maintenance and supportive care and coordination and provision of support services.

The Department of Health is responsible for the overall direction of the provincial Extra-Mural Program and strategically:

  • directs the development of the EMP in collaboration with stakeholders;
  • fosters the development of provincial forums to direct and advise on issues relating to the Program;
  • sets provincial policy and standards; and
  • monitors, plans and funds the program.

The EMP has a high level of patient satisfaction (95% highly satisfied, NBHC 2015 Home Care Survey).   However, the success of the program is creating demands for even more services.  The number of EMP patients utilizing the emergency department for care is increasing. In 2016-17, over 30,000 patients received care by the EMP and the majority (90%) waited as long as 33 days for their care.  The target for access to care is 10 days or less.  In 2016-17, EMP patients visited the emergency department for care over 18,000 times, were not admitted and were able to return home.  The majority of these emergency room visits were deemed to be avoidable.

In 2016/17, 32% of the referrals were from community physicians’ offices.  The goal is to increase timely and appropriate referrals from both hospital and primary care providers in the community, thereby avoiding unnecessary emergency department visits and hospital admissions. 

The need for a province-wide, integrated Community Home Care Support System to support the long-standing Extra Mural Program has been recognized for some time. The province needs an integrated solution that facilitates the collection and sharing of pertinent clinical and administrative data.

Palliative Care

Palliative care services are currently provided in a variety of settings, including patient homes, residential facilities, hospices, special care homes and nursing homes, by primary care providers with minimal access to a designated palliative care team outside of hospitals. As the burden of disease increases, due to the aging population and a continuing shift toward more in-home and community-based services, the need for access to consultation and/or care from a palliative care team in the community will continue to increase.

New Brunswick palliative care patients have some of the longest lengths of hospital stays and number of hospital deaths in the country. As reported by CIHI in 2010Footnote 1 , New Brunswick had the highest percentage of hospital deaths in Atlantic Canada, representing over 67% of decedents; in 2013Footnote 2 , Statistics Canada reported that 77.2% of cancer deaths occurred in NB hospitals.

Moving Forward – The New Brunswick Family Plan – Improving Access to Primary and Acute Care

The Family Plan builds on the objectives and achievements of existing initiatives and strat­egies of government, such as the Provincial Health Plan, Primary Health Care Framework, Chronic Disease Prevention and Management Framework, Home First Strategy and the Aging Strategy for New Brunswick.

Improving Access to Primary and Acute Care:  This is the culmination of efforts undertaken in these areas and sets the pathway for moving forward. It is based on current initiatives, ongoing commitments and stakeholder feedback, and delineates the goals and actions that will help to improve the health and well-being of New Brunswickers through sustainable and improved primary, acute and long-term care systems.

Strengthening and adding actions to this plan will help to ensure that we meet the needs of New Brunswickers by providing a more coordinated approach to health care that will help en­sure a seamless continuum of programs and services from beginning to end of life. The focus will be on improving acute care services while ensuring greater access to primary health care services and more appropriate supports in the home or long-term care settings. To have a sustainable health care system for New Brunswick with better health outcomes, there must be a shift from a systems approach to an approach focused on patients living healthy lives in their communities.

Shifting the Focus from Hospital-Based Care to Preventative Interventions, Primary Health Care and Access to Care in the Community: A system focused on preventative and primary health care in the home and the community will lead to healthier New Brunswickers, as each person’s health is better managed through regular access to a primary health care provider who knows the patient’s history rather than depending on episodic care in the emergency department or walk-in clinic. Prevention must include a focused approach on the determinants of health to optimize the health and well-being of all New Brunswickers. Home and community care support must be strengthened to respond to increasing need in rural and urban areas. Initiatives such as community health needs assessments help provide a better understanding of health needs and are a step forward in ensuring better and more responsive access to care in the community.

Developing a model of integrated and coordinated health care services for more con­sistent and appropriate care is one initiative in particular that will have a positive overall impact on primary and acute care. The intention is to eliminate silos among these services and create additional capacity to care for persons in the community, by avoiding unnecessary hospital admissions and shortening hospital stays. That model will not be fully successful without a strong emphasis on technology, in particular replacing current paper-based records with interoperable electronic health records. As part of the new Community and Home Care Support Strategy, interoperable records will help patients and families navigate the range of programs and services available, as well as obtain the right care or service, at the right place and the right time. The system will leverage the eHealth New Brunswick initiative through the Department of Health and provide the Extra-Mural Program with up-to-date information when visiting patients in their homes.

New Brunswick will also continue to pursue collaborations with key partners, such as Canada Health Infoway, to advance digital health innovation throughout the province’s health system. Opportunities to collaborate on a regional level with partner provinces will be a focus of these efforts.   

In addition, developing a coordinated and integrated approach to palliative care services will support a paradigm shift to providing this type of care in the community. Working together to ensure high-quality palliative care services to reduce suffering for persons living with life-limiting illnesses and their families can be achieved through the development of an integrated approach to palliative care, enhanced palliative care knowledge, use of standardized assessment and monitoring tools, more hospice options for urban and rural communities, and a physician model for palliative care.

Finally, a new approach to family medicine will be implemented with the New Brunswick Medical Society in which family physicians work in teams to help increase access to primary care. This new model is being driven by and will be managed by physicians. It will focus on effective chronic disease management and preventive health care. It will increase the involvement of physicians, nurses and allied health professionals in community care, and provide patients with evening and weekend access, which in turn will decrease demand on emergency rooms and walk-in clinics. This part of the New Brunswick Family Plan will be funded independent of this agreement, as cost-shared federal funding will be directed to the other priority areas identified below. 

Priority Areas for Cost-Shared Investment

The following Home and Community Care initiatives will be supported with additional federal funding to advance and accelerate the Improving Access to Primary and Acute Care pillar of the New Brunswick Family Plan, and are consistent with the actions contained in
Annex 1 - A Common Statement of Principles on Shared Health Priorities.

1.      Integration of Community Care Systems

New Brunswick is bringing the Extra-Mural Program, Ambulance New Brunswick, and the Tele-Care 811 systems under one management structure. 

The intention is to eliminate silos among these services and create additional capacity to care for citizens in the community, by avoiding hospital admissions and decreasing existing hospital length of stays. 

The new model will have three areas of focus:

  • Extending the time that care is provided in the community and delaying interactions with the institutional health care sector for as long as possible;
  • Increasing community health care capacity to increase the number of hospital discharges of patients back to communities; and
  • In conjunction with Family Medicine New Brunswick, increasing the referrals and interactions between family physicians and allied health professionals for patients that reside in the community.

Additional federal funding will be used specifically to support the development and implementation of clinical protocols that will be measured quarterly against established key performance indicators and designed to achieve the following benefits and outcomes.

Benefits/Outcomes

The following improvements are expected from the proposed model:

  • Improved access to primary health care services;
  • Improved patient satisfaction;
  • Reduced hospitalizations;
  • Reduced visits to emergency rooms and walk-in clinics;
  • Reduced alternate level of care (ALC) days; and
  • Reduced variations in current service delivery, increasing the effectiveness of the continuum of care concept.

This investment aligns with the agreed-to Common Statement of Principles on Shared Health Priorities by:

  • Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care; and
  • Increasing support for caregivers.
2.     Community and Home Care Support System

The province has developed requirements and a 3-year implementation plan to respond to EMP’s need for the integration of technology and innovative business processes into the daily delivery of home care services. The plan identifies the components, the approach to implementation, and the technology solution to fulfill this need.

Where possible, the plan aims to integrate the new system with eHealth, allowing care providers to benefit from a more holistic understanding of a patient’s health history and, where appropriate, allowing EMP care providers to contribute information that will become a part of the complete client record.

Additional federal funding will be used specifically to implement a point-of-care electronic clinical information system to support EMP.  This solution will replace the current paper-based system.  The Community and Home Care Support System will be designed to assist in the planning, management and evaluation of services; assist patients to better self-manage their diseases; improve care planning and case management; improve quality of care; improve patient and provider safety; improve productivity for EMP health service providers; and decrease the risk of privacy breaches.

Benefits/Outcomes

The Community and Home Care Support System represents a set of potential benefits/outcomes that support patient-centric, coordinated care. Examples include:

  • Clinical workflows across multiple delivery organizations;
  • Enhanced timely communication with physicians and other providers thereby helping individuals achieve better self-management of chronic conditions and health outcomes;
  • Coordinated care plans;
  • Consolidate functions  (e.g. client demographic registration);
  • e-referrals and wait time management;
  • Access to integrated, clinically-relevant information, aligned with New Brunswick’s strategic plan for Telehealth;
  • Delivery of services at a location accessible to the patient/client;
  • Immunization registry, community health profiles, access to information on population health determinants; and
  • Improved operational, management and strategic reporting provincially.

This investment aligns with the agreed-to Common Statement of Principles on Shared Health Priorities by:

  • Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery; and
  • Increasing support for caregivers.
3.     Palliative Care Strategy

In order to support palliative care services in New Brunswick, strategic pillars have been developed under five themes: person-centered care, family support network inclusion, professional capacity, community capacity and regional health authority and provincial leadership.

With the support of the Government of Canada, the province will accelerate the implementation of its goals in these respects:

  • Regional health authority and provincial leadership – The province will ensure equitable funding and access to palliative care and support a paradigm shift towards care and death out of the hospital setting and preferably in the home;
  • Person-centred care – Health partners will ensure coordination and navigation capacity and provide essential information on care and options to patients;
  • Family support network inclusion – Health partners will engage and provide services to families and caregivers, including direct care and support services in the home to relieve caregiver burden in end-of-life care as well as bereavement services;
  • Professional capacity – Palliative care education will be provided for family physicians, as well as frontline providers working in hospitals, EMP, nursing homes, and home support services, recognizing that para-professionals have an important role in providing palliative care;
  • Community capacity – The province will support communities to enhance hospice services and create new capacity and alternative models for rural areas through related infrastructure investments.

The federal funding will be used for: palliative care education for providers and the public; the implementation of standardized assessment and monitoring tools; the development and implementation of a palliative care monitoring and evaluation framework; support to communities for the development of residential hospices, where appropriate; the development of alternate residential services in rural communities; and the development of a physician model for integrated community-based palliative care services. The province will also look to leverage other available federal resources in support of these efforts, including through Pan-Canadian Health Organizations.

Benefits/Outcomes

The following improvements are expected from the proposed model:

  • Compassionate care for patients and families in the community (home, residential facilities, special care homes, nursing homes and inclusive of First Nations communities);
  • Informed choices by patients and families;
  • Enhanced knowledge for health care and home support providers;
  • Enhanced communication with patient/family and providers while supporting more timely interventions through the use of standardized assessment and monitoring tools;
  • More efficient use of hospital resources through alternative care delivery models;
  • Enhanced access to palliative care teams in the community;
  • Increased access to hospice services, both volunteer and residential, including alternate residential hospice options for rural communities; and
  • Enhanced palliative care performance measurement, as palliative care indicators will be defined and used for on-going monitoring.

This investment aligns with the agreed-to Common Statement of Principles on Shared Health Priorities by:

  • Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care;
  • Enhancing access to palliative and end-of-life care at home or in hospices; and
  • Increasing support for caregivers.

The following table outlines the federal funding allocation for the priority areas of investment in home and community care for the fiscal years 2017-18 to 2021-22.

*Funding already provided through legislation.
**Allocations are notional. Funding allocations are subject to annual adjustment based on the formula described in section 4.2.3 of the Agreement.

 

2017-18*

2018-19**

2019-20**

2020-21**

2021-22**

Total**

Integration of Community Care Systems

1,280,000

5,720,000

5,890,000

5,890,000

9,330,000

28,110,000

Community and Home Care Support System

2,890,000

4,200,000

4,560,000

4,560,000

6,300,000

22,510,000

Palliative Care Strategy

 

2,500,000

3,000,000

3,000,000

3,000,000

11,500,000

Total federal funding

$4.17M*

$12.42M**

$13.45M**

$13.45M**

$18.63M**

$62.12M**

Mental Health and Addictions Services

Overview

The Action Plan for Mental Health 2011-2018 has provided a blueprint for significant change in New Brunswick’s mental health services landscape.  Although it has served as a guide to support changes and enhancements in the treatment of mental health issues in New Brunswick, it has also exposed gaps in the health care system relating to addictions and mental health.

The Enhanced Addictions and Mental Health Services in New Brunswick initiative was developed as a four-year plan (2018-2022) to help bridge these gaps and remain consistent with priorities previously established by Government. In addition, the Enhanced Addictions and Mental Health Services for New Brunswick initiative contributes to the New Brunswick Family Plan pillar “supporting those with addictions and mental health challenges”.

With this in mind, the Addictions and Mental Health branch of the Department of Health is planning next steps in order to ensure the continued focus on improving addictions and mental health services in the province.  The priority areas included in this initiative are to: modernize addictions services; increase prevention efforts for those at risk of suicide; integrate addictions and mental health into primary health care; improve forensic mental health services; and build capacity within communities to support those with addictions and mental health issues.

Historically, addictions and mental health services have been planned and delivered as separate entities, resulting in a disjointed and less responsive system.  Through initiatives such as the Action Plan for Mental Health and Integrated Service Delivery, the need has been shown for programs and services to be integrated and interdependent in order to ensure a comprehensive and responsive continuum of care.

Mental Health and Addictions Services in New Brunswick Today:

In New-Brunswick, community addiction and mental health services as well as inpatient mental health services are delivered through two regional health authorities. The services primarily pertaining to the treatment of those impacted by substance use and addictions include prevention, withdrawal management services, residential rehabilitation services, opioid replacement therapy as well as community-based treatment. These services are targeted to all age groups. Mental health services are provided to improve, restore and/or maintain the mental health and emotional well-being of the citizens of New Brunswick.  This is accomplished through providing treatment, rehabilitation and maintenance programs, as well as promotion/prevention. All programs focus on the individual and ensure individual and community involvement.

Mental health inpatient services are offered through the various psychiatric units of regional hospitals and the province’s two psychiatric hospitals.

Child and youth addiction and mental health services are offered through the Integrated Service Delivery (ISD) model which is designed to provide services and programs to children and youth with multiple needs. The services are offered in the school/community setting to children and youth up to age 18 inclusively, and up to the age of 21 for those within the public school system, who have identified multiple needs as defined by core areas of development, including physical health and wellness, emotional and behavioural functioning, family relationships, educational development and mental health.

The issues related to substance use in Canada and in New Brunswick are significant.  The Canadian Centre for Substance Use and Addiction, in its widely referred to document, The Cost of Substance Abuse in Canada, states that “problematic substance use is a significant drain on Canada’s economy through its direct impact on the healthcare and criminal justice systems, and its indirect impact on productivity, as a result of premature death and ill health.” New Brunswickers are also affected by the impacts of problematic substance use.  According to the recent (2017) Canadian Institute for Health Information (CIHI) report, alcohol is the most widely used psychoactive substance in Canada.  About 80% of Canadians report drinking alcohol and most do so moderately.  In New Brunswick, the self-reported rate of heavy drinking among adults is 21.5 %, compared to the national rate of 18%.  According to the CIHI report, alcohol is also the number one reason people are hospitalized.  In New Brunswick, the rate of hospitalizations for reasons entirely related to alcohol abuse is 172 individuals per 100,000.

Mental-health-related issues are also an important aspect of health care. Based on the Canadian Community Health Survey, New Brunswick reports poorer mental health than the Canadian population for ages 12-64 (64.1% of New Brunswickers rate themselves in very good to excellent perceived mental health; the comparable figure for Canada overall is 71.6%). A significant cost to the health care system is related to hospitalization rates. The Average Length of Stay in acute care is a very important factor for the patient’s stay. In 2015-16, 22.3% of the total length of stay was considered conservable.  In addition, while it is important to improve patient flow, it is also important to ensure that the readmission rate does not increase. In 2015-16, New Brunswick had a 30-day risk adjusted readmission rate of 10.7% compared to Canada’s 12.0%.

An average of 107 New Brunswickers are reported to die of suicide every year. However, suicide deaths tend to be under-reported. A death by suicide has serious psychosocial and economic impacts on surviving family members, friends, schools, and the community.  It is estimated that for every death by suicide, 150 other people are affected to varying degrees.  The average economic cost of a suicide in New Brunswick is estimated to be in the order of $850,000.  The New Brunswick self-injury rate had been decreasing in the past four years, down to 63 hospitalizations from 80 per 100,000 people. However, in 2015-16, this has increased to 76.  The New Brunswick rate of premature deaths from suicide/self-inflicted injuries currently stands at 38.6 per 100,000 population.

From 2011-15:

  • 70.4% of people in New Brunswick who completed suicide consulted their physicians 6.8 times in the 3 months prior to completing suicide; and
  • 27% of people who died by suicide were hospitalized in the last year of their lives.

The percentage of children and youth who receive mental health services within 30 days of being referred to services has remained stable over the past 3 years (51.4% in 2015-2016). Some key statistics are as follows:

  • For the recent fiscal year, sites with ISD phase 1 saw a significant increase in the number of children and youth referrals compared to non-ISD sites;
  • ISD sites saw a 52% increase in referrals from the previous year’s 6-month timeframe; whereas non-ISD sites had no increase;
  • The age range 5-11 saw a 234% increase in referrals; and
  • ISD sites saw an increase in services delivered in schools.

Moving Forward – The New Brunswick Family Plan – Supporting Those with Addictions and Mental Health Challenges 

The Family Plan builds on the objectives and achievements of existing initiatives and strat­egies of government, such as the Action Plan for Mental Health, Provincial Health Plan, Wellness Strategy, Home First Strategy and the Aging Strategy.

Supporting Those with Addictions and Mental Health Challenges:  Work under this pillar is based on current initiatives, ongoing commitments and stakeholder feedback, and lays out the goals and actions that will help address the challenges in achieving a better balance between prevention and the provision of care going forward.

The goals and actions of this plan will help create a system that is responsive to individual, family and community needs, and one that is more accessible and coordinated with better supports and outcomes for our citizens. The focus will be on renewing our collaborative efforts so that New Brunswickers suffering from addictions and mental illness receive the care and support they require to live a fruitful and productive life.

Two initiatives in particular will have a positive overall impact on addictions and mental health:

The Enhanced Action Plan on Addictions and Mental Health: This plan will address continuity of care and access issues for a broader segment of the population. Building on the success of the ISD approach in schools, the Flexible and Assertive Community Treatment teams in communities and the implementation of the Supervised Community Care frameworks, the action plan will focus on ensuring evidence-based, person-centred services.

Without good mental health, New Brunswickers are at greater risk of developing addic­tions, mental illness and chronic diseases. To ensure individuals, families and communities have access to the programs and services they need, enduring gaps must be addressed. This will be achieved by focusing our efforts and undertaking concerted actions to achieve the areas of focus outlined below.

Adopting a Proactive Approach to Improving Mental Health: Developing mental fitness and resilience will support mental health and is key to overall health and well-being. As mental health is inter-dependent with physical health, earnings, education and standards of living, addressing gaps in the social determinants of health will also support popula­tion wellness. A proactive approach includes effective strategies and policies that serve to build resiliency as well as intervention practices that identify and address needs as early as possible.

Offering a Collaborative Model of Care through an Integrated, Person-Centered Approach to Service Delivery: A key direction in the delivery of addiction and mental health services is the collaboration of partners in all aspects of health care delivery to reduce fragmentation and enhance social inclusion. The application of integrated service delivery principles is critical to reducing wait times, enhancing an individual’s response to recovery and provid­ing a more positive experience for patients. In addition, treatment and recovery is equally enhanced when achieved through a person and family-centred approach where individ­uals are supported to make informed choices within an environment focused on recovery.

Offering Culturally Relevant Treatments and Services, Taking into Consideration the Individ­ual’s Social Context: To create and maintain a person-centred approach to service delivery, the system must be responsive to differences among those receiving health-care services (geography, age, language, gender and culture). To this end, care and consideration must be given to providing respectful, equitable and high-quality services within the context of diversity, including supporting First Nations and other Indigenous peoples through culturally rel­evant resources, community capacity building, training and knowledge exchange.

Enhancing the Knowledge and Awareness of Individuals, Families and Health Care and Other Service Providers:  Mechanisms to enhance the knowledge of all partners and service pro­viders are essential to ensuring that the health care system is attuned to the needs of service users. This can be achieved through better data collection and use, as well as research capacity and comprehensive evaluation frameworks for current initiatives. Additionally, persons living with an addiction and/or mental illness need to have current information on government programs and system supports to make educated choices regarding their treatment. Increased collaboration and the sharing of best practices across provincial departments, regions and organizations is also an effective means of addressing gaps.

Priority Areas for Cost-Shared Investment

The following mental health and addiction services initiatives will be supported with additional federal funding to advance the Improving Access to Primary and Acute Care pillar of the New Brunswick Family Plan, and are consistent with the actions contained in Annex 1 - A Common Statement of Principles on Shared Health Priorities.

1.     Enhanced Action Plan on Addictions and Mental Health

Enhanced addictions and mental health services in New Brunswick will be implemented to help bridge gaps and remain consistent with priorities previously established by Government. Historically, addictions and mental health services have been planned and delivered as separate entities, resulting in a disjointed and less responsive system.  Initiatives such as the Action Plan for Mental Health and ISD have demonstrated the need for programs and services to be integrated and interdependent to ensure a comprehensive and responsive continuum of care. It is important to note that development of the priority areas must be completed in an integrated and interdependent manner using evidence-based approaches to be successful. As such, New Brunswick will develop and implement a comprehensive framework for the delivery of services along the continuum of care, including: a process for interdepartmental case management for adults living with complex addiction and mental health needs; a structured day program; residential rehabilitation focused on treating concurrent disorders; and non-residential withdrawal management programs within the communities for a less intrusive option. Work will also be undertaken to enhance competency levels and skills within the workforce in New Brunswick.

Additional federal funding will be used specifically to:

  • Build community capacity by supporting NGOs and community organizations in the planning and delivery of support and services to allow clients to receive the right service at the right intensity and the right time;
  • Provide additional training for primary health care providers to better integrate addictions and mental health into primary health care;
  • Expand the after-hours mobile mental health services to day-time hours;  
  • Develop and implement a culturally-appropriate and competent framework for the delivery of mental health services to First Nations people, both youth and adults, within New Brunswick’s 15 First Nations communities. The goal will be to co-develop with First Nations partners and successfully implement multi-level, First Nations community-led, collaborative, strengths-based mental wellness teams;
  • Establish e-mental health services throughout the province allowing more people to get help, improve the quality of care delivered, reduce costs, and overcome challenges that are present in our current health care system; and
  • Implement mental health senior care services within all regions of the province.  These specialized health services will provide community-based, at-home service to seniors, augmenting their opportunity to remain well and in their homes as long as possible.
Benefits/Outcomes

The following improvements are expected from the proposed model:

  • Decreased levels of high risk/complex needs;
  • Increased access to addiction and mental health services for those justice-involved individuals;
  • Increased awareness of service availability on a continuum among family members and service providers;
  • Increased identification of needs at an earlier stage (prevention and early intervention);
  • Decreased wait times for assessment and direct service provision;
  • Increased capacity to adjust service intensity and duration according to the need;
  • Increased collaboration between partners in the provision of services and assessments, and reduction of redundancies and duplication;
  • Enhanced regional community-based service delivery capacity;
  • Decreased use of out-of-province placements for the treatment of complex addiction and mental health needs;
  • Increased access to culturally safe, community-centered mental health, addiction and healing approaches and services; and
  • Enhanced suicide prevention initiatives.

This investment aligns with the agreed-to Common Statement of Principles on Shared Health Priorities by:

  • Expanding access to community-based mental health and addiction services for children and youth (age 10-25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders;
  • Spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services; and
  • Expanding availability of integrated community-based mental health and addiction services for people with complex health needs.
2.      Integrated Community Mental Health Care Services for Youth

In December 2014, Government announced the establishment of a Network of Excellence for children and youth with complex mental health needs.  The Network will provide seamless support to youth in their communities and schools through a clinical foundation embedded in ISD, throughout a comprehensive continuum of care from prevention and promotion activities to the most tertiary level of out-of-home care: 

  • The Centre of Excellence is a 15-bed treatment facility for youth with complex mental health needs that is being constructed in Campbellton, NB.  It will open in the 2018-19 fiscal year.  The clinical staff at the Centre of Excellence will also provide outreach support around the province to assist youth in remaining in their communities.
  • ISD provides addiction and mental health services to children and youth in school/community settings.  It coordinates support with the Departments of Health, Education, Social Development and Public Safety.  It is currently being implemented in all regions of the province and presently serves all youth attending public school as well youth 18 and under not attending school.  In February 2017, this program received a National Public Sector Leadership Award from the Institute of Public Administration of Canada (IPAC).

Additional federal funding will be used specifically to:

  • Provide training and professional development to multidisciplinary teams established through the ISD initiative as well as all other frontline staff that interact with clients throughout the four government departments;
  • Fund integrated service delivery teams customized to the varying needs of each of the First Nation communities throughout New Brunswick regions that require specific multidisciplinary youth teams in addition to those currently established within the public school system; and
  • Ensure that the planned provincial treatment centre will be adequately staffed based on the determined service requirements. This facility will provide court-requested assessments in addition to treatment planning and provision for youth with complex needs.

Benefits/Outcomes

The following improvements are expected from the proposed model:

  • Increased school engagement and academic success;
  • Decreased levels of high risk/complex needs;
  • Increased diversion of youth from the criminal justice system;
  • Increased awareness of service availability on a continuum among family members and service providers;
  • Increased identification of needs at an earlier stage (prevention and early intervention);
  • Decreased wait times for assessment and direct service provision;
  • Increased capacity to adjust service intensity and duration according to child and family needs;
  • Increased sharing of information among partners and collaboration with community stakeholders;
  • Increased job satisfaction among services providers who serve youth, children and their families;
  • Increased co-ordination of services/resources provided by partners and the community;
  • Increased collaboration between partners in the provision of services and assessments, and reduction of redundancies and duplications;
  • Enhanced regional community-based service delivery capacity;
  • Decreased use of out-of-home placements pending assessment and intervention services; and
  • Decreased use of out-of-province placement for youth with complex needs.

This investment aligns with the agreed-to Common Statement of Principles on Shared Health Priorities by:

  • Expanding access to community-based mental health and addiction services for children and youth (age 10-25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders;
  • Spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services; and
  • Expanding availability of integrated community-based mental health and addiction services for people with complex health needs.

The following table outlines the federal funding allocation for the priority areas of investment in mental health and addictions for the fiscal years 2017-18 to 2021-22.

*Funding already provided through legislation.
**Allocations are notional. Funding allocations are subject to annual adjustment based on the formula described in section 4.2.3 of the Agreement.

 

2017-18*

2018-19**

2019-20**

2020-21**

2021-22**

Total**

Enhanced Action Plan on Addictions and Mental Health

 

3,000,000

4,010,000

7,120,000

7,120,000

21,250,000

Integrated Community Health Care Services for Youth

2,090,000

2,170,000

5,300,000

5,300,000

5,300,000

20,160,000

Total federal funding

$2.09M*

$5.17M**

$9.31M**

$12.42M**

$12.42M**

$41.41M**

Performance Measurement

The Department of Health has developed an accountability and monitoring framework in collaboration with the EMP leadership of both regional health authorities.  The framework supports strategic planning, continuous quality improvement and financial management of the program. The indicators below will be used to track progress.

The Health Analytics Branch of the Department of Health has also identified a resource to support and participate in the CIHI-led process to develop common indicators and will share data with CIHI on agreed-upon indicators.

Summary of Expected Results 

Initiatives

Outputs/Outcomes

Target by 2021

Home and Community Care

 

  • Integration of Community Care Systems

 

  • Community and Home Care Support System

1. Improve timely and appropriate access to home healthcare services referral to care time: the length of time from when a new EMP patient referral is received to the time the patient receives care. 

2. Decrease unnecessary EMP patient ED visits.

3. Increase referrals to EMP from community Primary Care Providers for appropriate and cost effective community care thus avoiding unnecessary emergency department visits or hospital admissions.

4. Effective and efficient utilization of EMP health professionals to decrease hospitalizations, support early discharge from hospital; prevent and delay institutionalization; and coordinate services in the community (Increase # of visits).

5. Maintain or improve patient home healthcare experience.

1. 90 percent of patients will receive care within 10 days or less from the date the referral is received.

2. Ratio of the number of EMP patients utilizing the ED equal or less than 0.51.

3. 8,911 referrals (20% improvement).

4. 90,000 annual additional visits (15% improvement).

5. 95% patient satisfaction.

  • Palliative Care Strategy

1. Less hospital deaths.

2. More deaths at home (in-home or residential facilities) and in the community (hospices, nursing home).

3. More palliative care team services in the community.

4. Increased hospice volunteer services and residential hospice care to support patients/families.

5. More in-home physician palliative care visits.

6. Informed choices by patients and families.

Measures and targets will be defined and incorporated as initiatives are developed and implemented.  All targets will be defined by December 2019.

Mental Health and Addiction Services

 

  • Enhanced Action Plan on Addictions and Mental Health

Decrease wait times for community addiction and mental health services in New Brunswick.

 

 

 

Measures and targets will be defined and incorporated as initiatives are developed and implemented. All targets will be defined by December 2019.

  •  Integrated Community Health Care Services for Youth

Decrease wait times for community addiction and mental health services in New Brunswick.

Increased system integration.

Measures and targets will be defined and incorporated as initiatives are developed and implemented. All targets will be defined by December 2019.

 

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