Canada-Nova Scotia 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 NOVA SCOTIA (hereinafter referred to as "Nova Scotia" or "Government of Nova Scotia") as represented by the Minister of Health and Wellness and the Minister of Addictions and Mental Health (herein referred to as "the provincial Ministers")

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

PREAMBLE

WHEREAS, on February 23, 2023, Canada and Nova Scotia 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 Nova Scotia 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, Nova Scotia 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 provincial Ministers are authorized to enter into Agreement; and

WHEREAS, Nova Scotians’ personal information is protected by the Nova Scotia Personal Health Information Act and the Nova Scotia Freedom of Information and Protection of Privacy Act;

NOW THEREFORE, this Agreement sets out the terms between Canada and Nova Scotia 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 Nova Scotia 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 Nova Scotia 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 Nova Scotia 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 Nova Scotia 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 Nova Scotia agree that, with financial support from Canada, Nova Scotia 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 Nova Scotia agree that, with Budget 2017 financial support from Canada outlined in 5.2.2, Nova Scotia 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 Nova Scotia 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 Nova Scotia 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 Nova Scotia 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, Nova Scotia 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 Nova Scotia'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, Nova Scotia 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 Nova Scotia

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 1st 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 1st 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 1st 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 1st from Statistics Canada;

K is the total population of Nova Scotia, as determined using annual population estimates on July 1st from Statistics Canada; and

L is the total population of Canada, as determined using annual population estimates on July 1st 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 Nova Scotia, as determined using the annual population estimates on July 1st from Statistics Canada; and

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

5.2.4 Subject to annual adjustment based on the formulas described in section 5.2.3, Nova Scotia’s estimated share of the amounts will be:

Fiscal Year	Working Together to Improve Health Care for Canadians Estimated amount to be paid to Nova Scotia^{table 1 note *} (subject to annual adjustment)	Budget 2017 Mental Health, Substance Use, and Addictions Services Estimated amount to be paid to Nova Scotia^{table 1 note *} (subject to annual adjustment)
2023-2024	$ 102,780,000	$ 15,720,000
2024-2025	$ 102,780,000	$ 15,720,000
2025-2026	$ 102,780,000	$ 15,720,000
Table 1 Footnote Table 1 Note * Amount represent annual estimates based on Statistics Canada’s July 1st, 2022, population estimates. Return to table 1 note * 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 Nova Scotia 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 Nova Scotia of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
Canada shall withhold payments if Nova Scotia has failed to provide reporting in accordance with 7.1.
Canada shall withhold the second payment in 2023-24 if Nova Scotia has failed to satisfy all reporting requirements associated with the preceding Canada – Nova Scotia 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 province’s Financial Officer, of funding received the preceding Fiscal Year from Canada for mental health and addiction services under the Canada – Nova Scotia 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, Nova Scotia 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 expenditures 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 Nova Scotia under subsection 5.2.4 of this Agreement in the next Fiscal Year.

5.4.3 Upon request, Nova Scotia 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 Nova Scotia 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 Nova Scotia 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, Nova Scotia 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 Nova Scotia 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 Nova Scotia 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, Nova Scotia 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 Nova Scotia 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 province’s 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 Nova Scotia 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 Nova Scotia will ensure that expenditure information presented in the annual financial statement is, in accordance with Nova Scotia's standard accounting practices, complete and accurate.

7.3 Evaluation

7.3.1 Responsibility for evaluation of programs rests with Nova Scotia 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 Nova Scotia will make publicly available, clearly identified on a Government of Nova Scotia website, this Agreement, including any amendments.

8.5 Canada, with prior notice to Nova Scotia, 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 Nova Scotia 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 Nova Scotia 10 days advance notice, including advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

8.7 Nova Scotia reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Nova Scotia 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 Nova Scotia agree to participate in a mutually agreeable joint announcement upon signing of this Agreement.

8.9 Canada and Nova Scotia 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 Nova Scotia 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 Nova Scotia, 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 prior 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 Nova Scotia shall be:

Jeannine Lagassé
1894 Barrington Street,
Barrington Tower
PO Box 488
Halifax NS B3J 2R8

Email: ns.dhw.igr@novascotia.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 Nova Scotia.

13.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Nova Scotia 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
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
The Honourable Ya’ara Saks, Minister of Mental Health and Addictions and Associate Minister of Health

SIGNED on behalf of Nova Scotia by the Minister of Health and Wellness
The Honourable Michelle Thompson, Minister of Health and Wellness

SIGNED on behalf of Nova Scotia by the Minister of Addictions and Mental Health
The Honourable Brian Comer, Minister of Addictions and Mental Health

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 roadmap**

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

Introduction

Over one million people are served by Nova Scotia’s health care system. Nova Scotia is guided by Action for Health, a multi-year roadmap to transform the health system. Action for Health provides a vision, clear strategy, and solutions to create a world class health system in Nova Scotia. Action for Health provides a path forward for a completely different kind of healthcare experience and health culture for the province – one that is ready, reliable, and responsive and puts people at the center. A whole-of-government approach is being taken to deliver Action for Health and it requires integrated, system-wide solutions and investments to change the trajectory of our health system and health outcomes in Nova Scotia. Action for Health focuses on innovation and finding new ways to address long-standing generational issues within the health system.

Our strategic plan is evidence-based and Nova Scotian-informed. We are advancing six core solutions to the people of Nova Scotia, each with its own objective for creating an efficient, modern, equitable, and respectful health ecosystem. The work, actions, and investments generated by these solutions will make an impact in the short and the long term.

Solution One: Become a Magnet for Healthcare Providers
- Our government will make Nova Scotia a sought-after place for healthcare providers by offering a simple, streamlined recruitment experience that leads directly to jobs in healthy, safe workplaces and a home in welcoming communities. In our vision, healthcare providers from all communities are represented, respected, valued, and heard. Using world-class technology and with information at their fingertips, they are connected to and supported by a network of peers across Nova Scotia to provide high-quality, culturally appropriate care, informed by best practices and research. People enjoy work-life balance, robust benefits and a workplace approach that revolves around respect, sustainability, and continuous quality improvement.
Solution Two: Provide the care Nova Scotians need and deserve
- Imagine a system where Nova Scotians receive people-centred, flexible, quality healthcare throughout life, when they need it. Whether interacting with a primary healthcare provider, finding addictions or mental health support, seeking help in an emergency, managing chronic disease or accessing continuing care as they age with dignity, Nova Scotians deserve a response that is compassionate, equitable, effective, and informed by evidence. By thinking differently about healthcare delivery across the continuum of care, embracing data, metrics, modern tools and technology, and leveraging staff expertise and experience, people get the right care in the right place at the right time from the right care team.
Solution Three: Cultivate excellence on the frontlines
- We will build care teams that work together and have the information, technology, and tools they need to provide a high standard of care. Healthcare workers entering the field will be well-prepared and mentored. Other best practices, along with performance and outcome measures, will drive improvements in care and motivate all involved. The culture will shift to be collaborative, people-centred, and results focused, becoming a driver of innovation, industry, and our economy.
Solution Four: Build in accountability at every level
- Our transformed health system will be coordinated and equitable, with a shared understanding of expectations, roles, responsibilities, and success driving high performance. Healthcare providers will connect to other areas of the system to support continuity and a quality patient experience. Value for money improves as innovation and collaboration lead to better population health and patient care, and enhanced well-being of care teams. Areas for improvement will be continuously assessed based on patient outcomes and experience, provider experience, and dollars invested. Every person will strive for cultural competence in an environment of respect, collaboration, and learning. Transparency and openness will help Nova Scotians understand what’s happening and why decisions are being made.
Solution Five: Be responsive and resilient
- Approaching health proactively bolsters health equity, addresses social determinants of health, and builds on learnings from the COVID-19 pandemic. Investing in public health, research, preparedness, and emergency response will build a system that can weather ups and downs and will position us for a healthy future. With more decisions informed by local needs, people and communities will become active contributors to a healthy, equitable, diverse health system. By focusing on keeping Nova Scotians healthy, and managing chronic disease and other public health issues, we will meet the health challenges of today and tomorrow.
Solution Six: Address the factors affecting health and well-being
- We will provide supports and empower partnerships, people, communities, governments, and organizations to work together to achieve good health and well-being. When we address long-standing barriers to better health, including inequities and social determinants like food security, housing, racism, and discrimination, Nova Scotians will experience improved health and a better quality of life. As we respond and move forward from the COVID-19 pandemic, we will work to strengthen community-based primary care, mental health supports, public health, and health promotion, while learning from and collaborating with diverse populations. Over time, this will reduce pressure on the health system and contribute to its sustainability.

Nova Scotia welcomes federal support and partnership towards implementing Action for Health. The Shared Health Priorities outlined by Health Canada, and agreed to by all jurisdictions, complement and align with Nova Scotia’s Action for Health plan and each of the six solutions.

Under the Working Together to Improve Health Care for Canadians plan, funds will build on and progress provincial priorities across four key areas: access to family health services, health workforce and backlogs, mental health and substance use, and a modern health system. In this action plan we have highlighted solution alignment and are providing examples of annual investments that could be made for each priority area. These examples represent segments of significant plans that Nova Scotia already has in place to transform the healthcare system. Planning for 2023-24 budget year included anticipation of the funds to be received under the Canada-Nova Scotia Agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26). While linked to a larger, provincial strategy, the specific initiatives included in this action plan are made possible with this funding.

Indigenous Health Transformation in Nova Scotia

Nova Scotia recognizes and acknowledges that Indigenous people in Nova Scotia, who are predominantly Mi’kmaw, experience health disparities due to colonization, systemic racism, and generations of cultural, social, and historic disadvantages. Nova Scotia is on a committed journey to forming true partnership with Mi’kmaw partners to address the health disparities experienced and close the health gap.

On April 21st, 2023, Nova Scotia and Canada signed a trilateral Memorandum of Understanding (“MOU”) with the Mi’kmaq of Nova Scotia as represented by Mi’kmaw health and wellness organization, Tajikeimɨk. The MOU commits the parties to creating a culturally safe, comprehensive, trauma-informed and high-quality health and wellness system.

The Department of Health and Wellness, through its work with Tajikeimɨk, is committed to supporting the Mi’kmaw-led health priorities and improved health outcomes for Mi’kmaq and other Indigenous groups. Many actions identified under Action for Health will specifically support Mi’kmaw communities or individuals or have included Mi’kmaw partners in the design and implementation.

Nova Scotia will continue to support and demonstrate meaningful engagement with Indigenous partners to address gaps, support Indigenous health priorities, and work toward eliminating health inequities for all. We are committed to utilizing federal funds to advance reconciliation efforts, recognizing Indigenous rights to fair and equal access to quality and culturally safe health services free from racism and discrimination. These efforts will be reflected in both this action plan and in in action plans to come.

Funding through this provincial-federal agreement will fund dedicated initiatives to support the advancement of Indigenous health priorities across the province.

A Commitment to Health Equity in Nova Scotia

Nova Scotians voiced what matters most to them about their healthcare through extensive public engagement over the past two years. An important theme heard throughout these engagements was the need for greater health equity, defined as an effort to ensure all Nova Scotians have safe, fair and equitable access to the health services they need to achieve the best outcomes.

Through Action for Health and as legislated under the province’s Dismantling Hate and Racism Act, Nova Scotia is leading through implementation of a health equity framework for the province. This framework is one of the only frameworks of its kind in Canada, and will call for actions to make Nova Scotia's health system more appropriate, effective, and free from barriers and discrimination. Nova Scotia’s health equity framework will ensure access for equity and Indigenous communities and individuals, including those in official language minority communities.

Shared health priorities and description of initiatives

1. Family health services: Expanding access to family health services, including in rural and remote areas

Estimated Annual Investment: $48,154,000 per year

As of June 1, 2023, 15% of Nova Scotians are without a primary care provider. It is critical that Nova Scotians have a place to go when they need primary care– whether a family physician or by accessing care at a Primary Care Clinic or through other means. We are investing in primary care to improve timely access and attachment of families to primary healthcare providers.

Nova Scotia is also investing in virtual care to improve timely access to care. Various virtual care programs help to provide better access for patients, enhancing and expanding care for those living in rural and remote areas of the province. Additionally, we have created primary care clinics that are intended to specifically deliver services to those waiting for a family practice. Action for Health provides solutions that enhance access to care across the system, including family health services.

Solutions may include:

Developing innovative primary healthcare models to deliver care when, where, and how it’s needed.
Articulating a clear primary healthcare strategy that addresses more systemic issues of access and attachment.
Focusing on keeping current healthcare workers through retention efforts and supports aimed at rebuilding the resilience of the health workforce.
Proactively addressing factors affecting health with accessible and comprehensive primary healthcare, public health, and health promotion.
Exploring opportunities to expand the role of healthcare providers, such as nurses, pharmacists, and paramedics, to support delivery of health services.
Supporting improved primary healthcare in Indigenous communities across the province.
Investing in community-based health services for newcomers, including child and youth services.
Launching mobile primary healthcare clinics to help bridge the gap in primary care services.
Improving patient navigation and resources so they have assistance in finding the right care provider and location/option.

Initiatives to be supported by the Canada-Nova Scotia Agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26) to enhance family health services include:

Expanded Access to Care

New and strengthened approaches and investments in primary care, urgent care, and emergency care, including clinics and teams that will connect more Nova Scotians to primary care they can count on, specifically family practice teams, primary care clinics, after-hours clinics, urgent care centres and urgent treatment centres. For example, throughout the province, we will support expansion of Primary Care Clinics and Urgent Treatment Centres, stabilize existing Collaborative Family Practice teams, and enhance Health Home team-based care. We will also test and try an innovative mobile primary health care service to delivery primary health care when, where, and how it's needed. Intended outcomes of this initiative include increased access to urgent primary care visit when one is needed, increased access to a range of providers, and reduced hospital admissions for people whose complex needs could have been addressed with primary healthcare.

Community-Based Health Solutions

Supporting communities to provide, strengthen and enhance access to primary care through Community Health Centres and similar community-based primary health service centres, community-based organizations, and Community Pharmacy Primary Care Clinics expansion. Intended outcomes of this initiative include better access to care for rural areas and community grown solutions to increased access to equitable, evidence-based, primary health care services and supports in communities across Nova Scotia.

Improve Culturally Appropriate Services

Investment in culturally appropriate and relevant services for communities in Nova Scotia that face barriers in accessing healthcare and systemically induced, poorer health outcomes. For example, we will invest in Indigenous patient navigation program, Indigenous and African Nova Scotian Health Consultants, and funding to increase availability of Indigenous language interpretation & translation services. We will also expand prideHealth provincially, allowing greater access to Gender Affirming Care and it supports increased access to Primary Care services for 2SLGBTQIA+ communities. Expected results of this initiative include built public trust in how Indigenous, Black, racialized, and equity groups navigate and interact with the health systems, increased diversity in the NS health workforce, ensuring health workforce better reflects the communities it serves and increased patient-centred supports to address racism and discrimination within the health system.

Modernizing Family Health Care

Investment in technological and digital health advancements to enhance primary care: virtual urgent care for patients who have an immediate, but not life-threatening situation that needs the attention of healthcare provider but may not need the services of an emergency department, enhancements to a family practice registry tool, and cardiac rehabilitation. Intended outcomes for this initiative include improved navigation of available care options for those waiting attachment, improved system and resource planning, and increased access to urgent primary care visit when one is needed.

Seamless Access to Care

Ensuring those without a family doctor continue to have access to primary care, through mobile health services, clinical efficiencies, and practice supports. Expected results of this initiative include enabled recruitment, accessible practice supports, and increased access to a range of providers.

Health workforce and backlogs: Supporting our health workers and reducing backlogs

Estimated Annual Investment: $17,263,000 per year

Recruiting and retaining health workers is one of the most pressing issues facing healthcare today and is critical to delivering high quality care equitably across the province. Our population is growing (rising 35,341 (+3.53%) from January 1, 2022) with more residents requiring public health care services. At the same time, many doctors in the province are reaching the end of their careers. Over half of the registrants that recently joined the Need a Family Practice registry indicated they joined because their provider has moved, retired, or is about to retire. Action for Health recognizes these potential challenges to health care and is creating opportunities for investment in both rural and urban areas to make Nova Scotia a sought-after place for new or newly-trained healthcare providers.

Nova Scotia has an Office dedicated to ensuring recruitment and retention of enough doctors, nurses and other healthcare professionals for Nova Scotians to get the care they need. The role of the new Office of Health Care Professionals Recruitment (OHPR) is to create the environment for successful recruitment and retention of health care professionals across the province. Since the establishment of the OHPR, there have been new investments and multiple targeted initiatives to increase the number of health care workers in the system and retain workers that are already working in the health care system. This requires a multipronged and innovative approach, which includes working collaboratively with partners across the system.

Regarding the reduction of backlogs, investments are being made to improve access to timely surgeries and diagnostics across the province – from Yarmouth to Cape Breton. Nova Scotia’s focus is on optimizing capacity – using our existing operating rooms and perioperative teams as efficiently as possible. We are also enhancing health human resources, recognizing this may take time and creative solutions to achieve. The province has also implemented an electronic referral (e-Referral) and central intake model for surgical referrals and diagnostic imagining requisitions, with plans to launch a centralized booking system for surgery. This system will provide better transparency to patients who can now see the status of their referral, or requisition, and allows them the option to be referred to the first available surgeon.

To ensure federal funding is used as intended, implemented in a timely manner and evaluated as required, federal funding will be used to support a project management team. This cost is included in the overall cost attributed to the listed initiatives. This funding will also be used to create designated positions for Indigenous employees that will provide culturally appropriate advice and expertise to intergovernmental relations and trilateral tables.

Solutions may include:

Streamlining the recruitment experience to attract qualified healthcare providers, including those from underrepresented groups.
Investing in education and training communities to ensure the health needs of communities are met.
Increasing supports for local recruitment efforts, showcasing Nova Scotia’s warm and welcoming culture.
Investing in recruitment and retention strategies for all healthcare professionals across the province, including strategies to support those working in Indigenous communities.
Understanding and addressing systemic racism, oppression, and discrimination in recruitment and retention strategies.
Accelerating and supporting the integration of qualified internationally educated and trained healthcare providers.

Initiatives to be supported by the Canada-Nova Scotia Agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26) to enhance recruitment and retention include:

Recruitment

Support organizations and communities to recruit priority professions in all areas of the province, including rural, remote, and areas with specialized teams. This will include investing in increasing capacity in our HHR recruitment team, engagement and mentorship for Black youth in the province, and investing in nursing-related recruitment activities. Some intended results from this initiative include internal capacity to ensure health human resources (HHR) recruitment is optimal, and enhanced ability to support engagement, cultural appropriate services and capacity building within African Nova Scotian and People of African Descent communities.

Retention

Retain and grow existing talent in Nova Scotia through wellness and recognition, professional development, retention incentives, and improved work environments resulting in fewer HHR job vacancies, increased job satisfaction among health care professionals, and increased representation of equity-deserving health human resources.

Reducing backlog

Advancing upstream screening, monitoring and diagnostic access to ease demand on surgical procedures. Through this initiative, Nova Scotia hopes to ease demand on the surgical backlog.

Addictions and mental health: Improving access to quality mental health and substance use services

Estimated New Annual Investment $19,343,000 per year

In Fall 2021, Nova Scotia created a dedicated Office of Addictions and Mental Health (OAMH). OAMH has a mandate to create a Universal Mental Health and Addictions system of care. This work is closely tied to Action for Health, the province’s roadmap for a health system where Nova Scotians can access world-class healthcare in a timely manner. A universal system will provide solutions to increase access to mental health and addictions care. Building a universal system requires service delivery models that are tailored to the varied needs of the population, address gaps along the continuum of mental health and addictions need, make it easier to move between services as an individual’s needs change, reflect evidence, and are shaped by community voice. Nova Scotia is leading the way forward in this work. Nova Scotia knows that mental health capacity and response is required broadly across the system – for this reason, many of the initiatives planned for this priority touch on all four broad priorities of this agreement. For example, training will be offered to health care professionals in our provincial training centre, including to those providing primary care services. We will support nurses to be specialized in mental health and additions, which is also linked to health human resource capacity building generally.

Supporting improved mental health and addictions supports for Indigenous communities in Nova Scotia is also a top priority. In 2022, the Province provided $2 million in funding to support a Mi’kmaw MHA strategy through the new health and wellness organization, Tajikeimɨk. This organization is leading the design and delivery of health services to improve the overall wellness of Indigenous people in the province. The health transformation process through Tajikeimɨk “…will build on, grow and evolve the health and wellness services and programs used by Mi’kmaw people in Nova Scotia, with a focus on high-quality, culturally safe and wholistic approaches.”

Solutions may include:

Reducing gaps in access to care with strategic investments in addictions and mental health.
Developing a workforce strategy to meet the mental health and addictions needs of Nova Scotians.
Working with organizations inside and outside of government to ensure management of standards of care, best practices, and models of care.
Continuing support for harm reduction programs, including managed alcohol programs, needle exchanges, overdose prevention sites, and naloxone.
Improving the integration of mental health and addictions services across the health system, including primary healthcare and emergency departments.
Developing targeted solutions for people facing the greatest barriers to accessing addictions and mental health services.

Initiatives to be supported by the Canada-Nova Scotia Agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26) to enhance mental health and substance use services include:

Universal Mental Health and Addictions Services

Developing a system so Nova Scotians have greater access to addictions and mental health services, where and when they need it. For example, we will support a pilot that will inform the creation of clinical pathways between public – private systems, informing the building of a universal MHA system while also increasing access to MHA services. Expected outcomes of this initiative include Improved recovery and quality of life for people living with mental illness and their families, increased student access to clinical and interprofessional training, increase in access to services for marginalized groups including low SES, Indigenous, First Nations, etc., and increased access to assessment services.

The Right Professionals for Nova Scotia

Investing in the training and recruitment of the right professionals to support the delivery of mental health and addiction (MHA) services. For example, development of an Advanced Practice in Mental Health & Addiction stream at Dalhousie School of Nursing as part of the Master of Nursing degree. The program will increase the number of RN graduates who will have specialized training to work in the MHA system. With this initiative, Nova Scotia hopes to see clinical practice leads in place in adult community MHA, improved effectiveness and efficiency of NSH adult community MHA, and resource availability to cover physician costs.

Supporting Youth

Supporting youth to receive care in community through low barrier service delivery models that respond quickly to promote wellness, provide brief intervention, and assist to navigate the system. For example, we will scale the Integrated Youth Service model to eight sites across the province to provide support to youth aged 13 to 25 and their caregivers. An expected outcome of this investment is children/youth and caregivers receiving services are satisfied with the service and experience positive results.

Prioritize Equity Diversity and Inclusion

Delivering a better patient experience through new and improved service delivery models, shaped by the voices of communities, resulting in equitable and inclusive access available through culturally appropriate services. An example of programming to be supported is establishing an Afrocentric model of MHA services designed by the African Nova Scotian community.

Trauma Informed System

Improve the capacity of the MHA system to become a trauma informed system that does not retraumatize clients and families. For example, creating a provincial training center for trauma informed care to ensure that trauma is recognized and addressed. Intended outcomes of this initiative include improved wellness and resilience of our Nova Scotia workforce, improved patient and family experience in MHA services, and improved capacity of the MHA system.

Substance abuse

Delivering service delivery models intended to reduce harm and improve the quality of life for individuals experiencing substance abuse. For example, support will be provided for addiction medicine services, including the new provincial Withdrawal Management Service Delivery Model, Recovery Support Centers, physician resources for inpatient and outpatient withdrawal management, and establishment of an inpatient addiction medicine consult service at the QEII. Intended outcomes of this initiative include implementation of integrated addiction medicine services, availability of a continuum of harm reduction services in the province, and care in the community for individuals with addictions.

Investment of the Four Remaining Years of the 2017 Common Statement of Principles on Shared Health Priorities

Estimated Investment per Year (Previous Bilateral Agreement): $15,700,000 per year

With the remaining 4 years of funding for MHA services associated with the 2017 Common Statement of Principles on Shared Health Priorities, Nova Scotia plans to continue to fund the following MHA initiatives that were originally included in the Nova Scotia Action Plan on Home and Community Care and Mental Health and Addictions Services:

Enhancing Integrated Service Delivery for Children and Youth

Reduce the barriers that children and youth face accessing early intervention and prevention MHA supports with investments in:

Autism Intensive Outreach Team to provide short-term behavioural interventions.
- Intensive Outreach teams across the Province that provide a short-term intensive intervention, to children and youth with complex presentations and significant behavior difficulties, and their families. Teams provide capacity building for families, schools, DCS providers, health providers, group home staff, recreation staff etc. and will support patients and families with Autism within their own environment. Intervention will focus on crisis stability, case formulation and capacity building.
Sustain additional mental health clinicians in the SchoolsPlus program.
- SchoolsPlus is a collaborative interagency approach supporting the whole child and their family with the school often as the center of service delivery. SchoolsPlus employs, through the Department of Education and Early Childhood Development (EECD), SchoolsPlus facilitators who work to bring a range of services, including mental health services, together with mentoring, social work, after school programing, homework support, recreational and justice services into schools where students and families can easily access them. In addition, EECD employs SchoolsPlus Community Outreach workers who are focused on outreach to services outside the school setting that are needed to meet the needs of the children and youth.
- Child and youth mental health is supported within the SchoolsPlus approach by attaching children, youth and their families with MHA clinicians and community supports. Mental health clinicians employed by the NSH or the IWK provide clinical services support e.g., counselling, to students who are referred for such services. These clinicians work within the school setting or other settings in the community to provide the services where the children and youth need them.
Enhance and sustain the existing adolescent outreach program in Cape Breton (formerly titled CaperBase) and support the expansion to other health zones.
- Adolescent Outreach Services (AOS) is a multi-component intervention that aims to identify youth (grades 6-12/12-19 yrs.) at risk of poor mental health and/or addictions outcomes early on, and works with them to enhance personal skill building, coping, and resiliency.

Enhancing Access to Community Based MHA Services

Continue to support the expansion of services to fill critical service gaps across the lifespan, with investments in:

Provincial central intake for MHA services.
- There is an intake team in each zone across the province to support service delivery. Clinicians will ask questions that help determine what services and supports best meet the caller’s needs and will connect the caller with services in their local area.
Crisis and urgent care services across the province.
- Crisis and Urgent Care Services are part of a continuum of mental health and addictions (MHA) services offered to Nova Scotians. Services are intended to de-escalate/stabilize clients in crisis, reduce unnecessary hospital admissions, reduce repeat/frequent ED visits.
Mental health clinicians hired to work in the community.
- Increasing access to community-based MHA supports for adults, children and adolescents, including integrated services between NSH/IWK and primary health care. Funding is being used to increase the number of mental health clinicians in the community sector, based on assessed need.
Virtual Care options for MHA services.
- Implementation of virtual solutions in Nova Scotia that enhance access to services by augmenting and or replacing traditional therapies. It also supports enhanced integration between MHA services and primary health care by diversifying the basket of service options available in primary health care settings.
Sexual Assault Nurse Examiner (SANE) program to Northern Zone.
- Sexual Assault Nurse Examiners, often referred to as SANEs, are registered nurses who have advanced training and expertise to provide specialized medical and forensic emergency care that includes supportive care, medical attention, provide information and additional resources, as well as evidence collection. They can provide expert testimony in court of law.

Modernizing the system: Modernizing the health care system with standardized health data and digital tools

Estimated Annual Investment: $18,024,000 per year

Action for Health reflects the need for digital solutions to enhance and complement increased access to healthcare information by patients as well as between health workers. Engaged health care leaders, workers and recipients flagged aging infrastructure as a key issue and urged investments in technology and physical infrastructure, including more patient-enabling tech tools and virtual care platforms.

Nova Scotia is focusing on better, more modern systems that will ensure we are getting people the care they need faster, better, in the right place at the right time, and more efficiently. We have recently announced the development of One Person One Record (OPOR), a new clinical information system that will replace or connect the systems healthcare professionals use daily to access and update patient information. Shorter wait times, better care, and giving health professionals more time with patients are some of the ways this work will help improve healthcare in Nova Scotia. It is also expected that through the implementation of this new system, patients will be able to easily access their own medical records. Interoperability between the various digital solutions, including those supported through the Canada-Nova Scotia Agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26), continues to be a consideration in the design phase of each solution.

Solutions may include:

Modernizing the patient experience by better supporting Nova Scotians in navigating the health system.
Continuing to invest and expand virtual care options for Nova Scotians.
Accelerating investments in technology and digitization to ensure care teams can provide quality, people-centred care that is culturally specific Support of languages other than English, particular for official language minority communities, is part of future enhancements to the digital tools outlined in this action plan.
Leveraging information and technology to connect care teams and enhance collaboration.

Initiatives to be supported by the Canada-Nova Scotia Agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26) by Modernizing the health care system include:

Digital tools to help Nova Scotians navigate the health system

Launching, enhancing and operating digital tools to help Nova Scotians navigate the health system and new technology to streamline care for cancer patients. This will include development and implementation of an application that will help Nova Scotians navigate the health system, including accessing info, booking services, and accessing virtual care. Also to be funded through this initiative is new technology to streamline care for cancer patients to create a single access point, improve communication, and foster data analytics. For example, we will create a single access point for patient records, referrals, and treatments, connecting the province’s eight community oncology clinics, allow streamlined communication between patients and clinicians, and foster data analytics that will generate real-time, relevant data on cancer care treatment in Nova Scotia. Through this initiative, Nova Scotians will have expanded virtual health care access, more prompt receipt of care, improved access, flow, and quality of care, better communication, and reduction in travel for patients.

Estimated Funding Allocation

The following table represents an estimated projection of spend across each priority area. Please note that this will be subject to change as planning for fiscal years 2024/25 and 2025/26 continues.

Initiative	Estimated Incremental Investments ($M)			Total
	2023-24	2024-25	2025-26
FAMILY HEALTH SERVICES
Total	$48,154,000	$48,154,000	$48,154,000	$144,462,000
Initiatives: Expanded Access to Care Community-Based Health Solutions Improve Culturally Appropriate Services Modernizing Family Health Care Seamless Access to Care
HEALTH WORKFORCE AND BACKLOGS
Total	$17,263,000	$17,263,000	$17,263,000	$51,789,000
Initiatives: Recruitment Retention Reducing backlog
MENTAL HEALTH AND ADDICTIONS
Total	$19,343,000	$19,343,000	$19,343,000	$58,029,000
Initiatives: Universal Mental Health and Addictions Services The Right Professionals for Nova Scotia Supporting Youth Prioritize Equity Diversity and Inclusion Trauma Informed System Substance Abuse
MODERNIZING HEALTH SYSTEMS
Total	$18,024,000	$18,024,000	$18,024,000	$54,072,000
Initiatives: Digital tools to help Nova Scotians navigate the health system New technology to streamline care for cancer patients
Total Working Together to Improve Health Care for Canadians	$102,800,000	$102,800,000	$102,800,000	$308,400,000
Total Common Statement of Principles Funding for MHA	$15,700,000	$15,700,000	$15,700,000	$47,100,000
Grand Total	$118,500,000	$118,500,000	$118,500,000	$355,500,000

Measuring and Reporting on Results

Nova Scotia is committed to working with the Canadian Institute for Health Information (CIHI) and federal data partners on progress indicators related to this funding agreement. Included in this action plan are the eight key headline common indicators, as well as identified Nova Scotia-specific indicators. Nova Scotia already publicly reports on many of these indicators through the Action for Health website – providing the public the opportunity to see progress being made on a quarterly or annual basis. While we are still developing equity-related indicators, we are the first province in Canada to have launched a race and linguistic-based data collection, which will greatly improve our ability to identify inequities in healthcare to help improve equity, inclusion and diversity in healthcare and address racism and improve equity-related outcomes across the system.

The following indicators reflect the key common headline indicators developed by the FPT working group led by CIHI as well additional indicators, beyond the key common headline indicators, that are tailored to Nova Scotia’s needs and circumstances.

Common Headline Indicators
Indicator	Baseline		Target	Timeframe
Family Health Services
Percent of Canadians aged 12 and over who report having a regular health care provider, including in rural and remote areas	86%		88%^{table note i}	2025/2026
Health Workers and Backlogs
Size of COVID-19 surgery backlog	-9%		0%	2025/2026
Number of family physicians (FPs), nurses (RNs), and nurse practitioners (NPs) per 10,000 population	14 FPs 103 RNs 2 NPs		16 FPs^{table note ii} 109 RNs^{table note iii} 2.4 NPs^{table note iv}	2025/2026
Mental Health and Substance Use
Percent of Canadians who report a diagnosed mood or anxiety disorder and needs for mental health care not met	10%		9%^{table note v}	2025/2026
Integrated youth services (IYS) availability	# IYS active sites	0	3 IYS active sites and 5 IYS under development^{table note vi}	2025/2026
Integrated youth services (IYS) availability	# IYS sites under development	1		2025/2026
Wait times for community mental health counselling	22		20 days^{table note vii}	2025/2026
Modernizing Health Systems
Percent of Canadians who have accessed their personal health information electronically at any time	17		25%^{table note viii}	2025/2026
Percentage of family health service providers and other health professionals (e.g., pharmacists, specialists, etc.) who can share patient health information electronically.	22*		40%^{table note ix}	2025/2026
Table Notes Table Note i 88% attachment is the national average. NS attachment was at 88.7% in 2015, before beginning to decline. Since ending a period of population decline on April 1, 2015, Nova Scotia's population has increased by 101,511 (as of January 2023). Population aging, particularly in rural and remote areas, continues to increase. Return to table note i referrer Table Note ii The target increase in the ratio of family physicians to population of 14.6% over baseline corresponds to the current proportion of the provincial population without a regular primary care provider. Return to table note ii referrer Table Note iii The target increase in the ratio of RNs to population of 5% over baseline corresponds to the forecasted increase in demand for RNs over this time period. Return to table note iii referrer Table Note iv The target increase in the ratio of NPs to population of 23% over baseline corresponds to the forecasted increase in demand for NPs over this time period. Return to table note iv referrer Table Note v The target takes into account that the most recent data available (10%) is from 2018, and it is assumed that this rate could have increased during the pandemic, when many mental health factors worsened. Additionally, this indicator is based on estimates from the Canadian Community Health Survey which has a wide confidence interval of over +/- two percentage points making changes in the estimate over time challenging to accurately measure. Return to table note v referrer Table Note vi Nova Scotia has committed to funding eight IYS sites across the province (two per health zone), with the first planned to open in 2023-24. Return to table note vi referrer Table Note vii Nova Scotia Government and health partners are working to implement a Universal Mental Health and Addictions Care (UMHAC) system that will improve access to services and resources related to mental health and substance use. As improvements to Nova Scotia’s mental health care system continue, this indicator should trend downward. Return to table note vii referrer Table Note viii The timelines for the deployment of the OPOR (One Patient One Record) Patient portal are still to be determined. It may not deploy until all health regions in Nova Scotia are converted (5+ years) or as regions are converted. Other potential initiatives are still concept stage. Return to table note viii referrer Table Note ix Key contributors – OPOR access (phased over 5 years), Provider portal, eReferral, and efforts to fill the gaps in patient longitudinal records. Return to table note ix referrer

Nova Scotia-Specific Indicators
Indicator	Baseline	Target	Timeframe
Family Health Services
% of Admissions for Ambulatory Care Sensitive Conditions	6.1%	5%	2025/2026
Health Workers and Backlogs
Percentage of non-endoscopic surgical services completed or wait times within benchmark	52.3%	65%	2025/2026
Mental Health and Substance Use
% of MHA Wait Time within Benchmark – Non-Urgent	51.9%	65%	2025/2026
30-day Readmission Rate for Mental Health and/or Substance Use	6.9%	5%	2025/2026
Modernizing Health Systems
Hours of administrative tasks removed	104,000	400,000	2025/2026

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Date modified:: 2024-03-19

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Canada-Nova Scotia Agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26)

Tables of contents

Funding agreement

1.0 Key principles and collaboration

2.0 Objectives

3.0 Action plan

4.0 Term of agreement

5.0 Financial provisions

Table 1 Footnote

6.0 Performance measurement

7.0 Reporting to Canadians

8.0 Communications

9.0 Dispute resolution

10.0 Amendments to the agreement

11.0 Termination

12.0 Notice

13.0 General

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

Introduction

Indigenous Health Transformation in Nova Scotia

A Commitment to Health Equity in Nova Scotia

Shared health priorities and description of initiatives

1. Family health services: Expanding access to family health services, including in rural and remote areas

Health workforce and backlogs: Supporting our health workers and reducing backlogs

Addictions and mental health: Improving access to quality mental health and substance use services

Modernizing the system: Modernizing the health care system with standardized health data and digital tools

Measuring and Reporting on Results

Table Notes

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