Canada-Saskatchewan 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 SASKATCHEWAN (hereinafter referred to as "Saskatchewan" or "Government of Saskatchewan") as represented by the Minister of Health and the Minister of Mental Health and Addictions, Seniors and Rural and Remote Health (herein referred to as "the provincial Ministers")

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

PREAMBLE

WHEREAS, on March 1, 2023, Canada and Saskatchewan 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 Saskatchewan 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, Saskatchewan makes ongoing investments in health consistent with its broader responsibilities for delivering health care services to its residents and in supporting diversity, equity, and the needs of First Nations, Inuit and Métis; and underserved and/or disadvantaged populations, including, but not limited to official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians) and 2SLGBTQIA+;

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 Executive Government Administration Act authorized the provincial Ministers to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Saskatchewan associated with the federal investment for four shared health priorities, and mental health, substance use and addictions services consistent with the Common Statement; and

NOW THEREFORE, this Agreement sets out the terms between Canada and Saskatchewan 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 Saskatchewan 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 Saskatchewan 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 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 Saskatchewan 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 Saskatchewan acknowledge a mutual intent to engage in a two-phased formal review process:

1. 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
2. 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 Saskatchewan agree that, with financial support from Canada, Saskatchewan will continue to build and enhance its health care system 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 Saskatchewan agree that, with Budget 2017 financial support from Canada outlined in 5.2.2, Saskatchewan 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 Saskatchewan 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 Saskatchewan 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 Saskatchewan 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, Saskatchewan 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 Saskatchewan'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 Upon signing renewed bilateral agreements, Saskatchewan 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 Saskatchewan

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

1. $2.5 billion for the Fiscal Year beginning on April 1, 2023
2. $2.5 billion for the Fiscal Year beginning on April 1, 2024
3. $2.5 billion for the Fiscal Year beginning on April 1, 2025

Budget 2017 Mental Health, Substance Use, and Addictions Services

1. $600 million for the Fiscal Year beginning on April 1, 2023
2. $600 million for the Fiscal Year beginning on April 1, 2024
3. $600 million for the Fiscal Year beginning on April 1, 2025

5.2.3 Allocation method

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

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

5.3 Payment

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

1. 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 also be paid within approximately 30 business days of execution of this Agreement by the Parties, subject to 5.3.1.g.
2. 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.
3. 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.
4. 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.
5. Canada will notify Saskatchewan 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 Saskatchewan of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
6. Canada shall withhold payments if Saskatchewan has failed to provide reporting in accordance with 7.1.
7. Canada shall withhold the second payment in 2023-24 if Saskatchewan has failed to satisfy all reporting requirements associated with the preceding Canada – Saskatchewan Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23, specifically to:
   • 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
   • submit an annual financial statement, with attestation from the Ministry of Health's Executive Director - Financial Services Branch, of funding received the preceding Fiscal Year from Canada for mental health and addiction services under the Canada – Saskatchewan 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.
8. The sum of both installments constitutes a final payment and is not subject to any further payment once the second installment has been paid.
9. 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, Saskatchewan may retain and carry forward to the next Fiscal Year up to 10 percent of funding that is in excess of the amount of the eligible costs actually incurred in a Fiscal Year and use the amount carried forward for expenditures on eligible areas of investment. Any request to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by their designated officials, at the Assistant Deputy Minister level (herein referred to as "Designated Officials"), and is subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis.

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

5.4.3 Upon request, Saskatchewan 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 Saskatchewan 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 Saskatchewan 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, Saskatchewan 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 Saskatchewan 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 Saskatchewan 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:

1. Refine the eight common headline indicators (outlined in Annex 3);
2. 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;
3. 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
4. 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 2SLGBTQIA+.

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, Saskatchewan agrees to:

1. 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.
2. Beginning in Fiscal Year 2024-25, report annually and publicly in an integrated manner to residents of Saskatchewan 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.
3. Beginning in Fiscal Year 2024-25, provide to Canada an annual financial statement, with attestation from the Ministry of Health's Executive Director - Financial Services Branch, 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:
   • The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year;
   • The total amount of funding used for each of the shared health priority areas that are supported by the federal funds;
   • If applicable, the amount of any funding carried forward under section 5.4; and
   • If applicable, the amount of overpayment that is to be repaid to Canada under section 5.5.

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

7.3 Evaluation

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

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

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

8.9 Canada and Saskatchewan 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 Saskatchewan 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 Saskatchewan, by the provincial Minister(s).

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

11.0 Termination

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

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

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

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

12.0 Notice

12.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter, email, postage or other charges prepaid. Any communication that is delivered will be deemed to have been received on 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
Or any replacement email provided by the federal Minister(s)

The address of the Designated Official for Saskatchewan shall be:

Assistant Deputy Minister
Ministry of Health
3475 Albert Street
T.C. Douglas Building
Regina, SK
S4S 6X6
Email:  Norman.O'Neill@health.gov.sk.ca
Or any replacement e-mail provided by the provincial Ministers.

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 Saskatchewan.

13.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Saskatchewan 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 Parties have caused this Agreement to be duly signed by the undersigned authorized representatives in separate signature pages in accordance with the following signature process, which together shall constitute one agreement and (ii) the Parties agree that facsimile signature(s) and signature(s) transmitted by PDF shall be treated as original signature(s). 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

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

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

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

SIGNED on behalf of Saskatchewan by the Minister of Health
The Honourable Everett Hindley, Minister of Health

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

SIGNED on behalf of Saskatchewan by the Minister of Mental Health and Addictions, Seniors and Rural and Remote Health
The Honourable Tim McLeod, Minister of Mental Health and Addictions, Seniors and Rural and Remote 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

Text description

The Roadmap outlines 8 categories of activities planned for fiscal years 2023 to 2027, followed by anticipated outcomes enabled. Notes are also included throughout to highlight a “milestone”, where “vendor input is required”, and/or when an activity is “continued” across multiple fiscal years.

Patient Summary

• Fiscal Year 2023
  • Alberta & Ontario Trial Implementation & onboard 2-3 Jurisdictions
  • Update based on Trial Implementations
  • Update and publish the Canadian Health Data Exchange (CA:FeX) Specification
• Fiscal Year 2024
  • Update specification to fully align to IPS/CA Core+ and reflect implementation feedback
  • Onboard remaining jurisdictions
  • Publish vendor conformance requirements and represent in national procurements [vendor input required]
• Fiscal Year 2025
  • Advance implementation and adoption
  • Pan-Canadian vendor compliance service *(Pan-Canadian interoperability compliance testing service in place, vendors conform to pan-Canadian standards in stages.) [vendor input required]
• Fiscal Year 2026
  • Advance implementation and adoption [continued]
  • Conduct performance evaluation
  • Update specification to reflect updated CA Core+ [milestone]
• Fiscal Year 2027
  • Advance implementation and adoption [continued]
  • Conduct performance evaluation [continued]

Data Portability

• Fiscal Year 2023
  • Develop Primary Care Dataset V1 & EMR Extract Specification V1 [milestone]
  • Represent Data Portability components in the Canadian Health Data Exchange (CA:FeX) Specification
• Fiscal Year 2024
  • Trial Implementation of specifications
  • Extend CA Core+ to include other settings (e.g. Acute Care, Mental Health)
• Fiscal Year 2025
  • Expand adoption and refinement to include LTC, Community Care and implementation feedback
  • Include requirements in national procurements (e.g. Acute Care, LTC, Mental Health, Community Care)
• Fiscal Year 2026
  • Expand adoption of Specifications
  • Complete specifications [milestone]
  • Pan-Canadian vendor compliance service *(Pan-Canadian interoperability compliance testing service in place, vendors conform to pan-Canadian standards in stages.) [vendor input required]
  • Conduct performance evaluation
• Fiscal Year 2027
  • Expand adoption of Specifications [continued]
  • Conduct performance evaluation [continued]

Patient Access

• Fiscal Year 2023
  • Assess patient data and access needs across jurisdictions
  • Assess the feasibility of IPA standard and decide on Canadian adoption of same
• Fiscal Year 2024
  • Co-design patient data access design/Blueprint to represent policy and consent in alignment with IPA
  • Implementation and refinement of the Canadian Health Data Exchange Specification to include Patient Access components [milestone]
• Fiscal Year 2025
  • Update data exchange specification to support patient Digital Identities
  • Expand adoption of Canadian Health Data Exchange Specification
• Fiscal Year 2026
  • Develop pan-Canadian guidance documentation for basic digital consent
  • Expand adoption of Canadian Health Data Exchange Specification [continued]
  • Conduct performance evaluation
• Fiscal Year 2027
  • Develop advanced guidance documentation to integrate policy and consent into data access
  • Expand adoption of Canadian Health Data Exchange Specification [continued]
  • Conduct performance evaluation [continued]

eReferral & eConsult

• Fiscal Year 2023
  • Consolidate existing specifications and publish pan-Canadian specification with procurement requirements [milestone]
• Fiscal Year 2024
  • Publish conformance requirements for vendors [vendor input required]
  • Implementation of pan-Canadian specifications
• Fiscal Year 2025
  • Evolve specification to integrate other services (e.g. PS-CA. Provider Directories and Digital Identities)
  • Pan-Canadian vendor compliance service *(Pan-Canadian interoperability compliance testing service in place, vendors conform to pan-Canadian standards in stages.) [vendor input required]
• Fiscal Year 2026
  • Complete Specification [milestone]
  • Conduct performance evaluation [continued]
• Fiscal Year 2027
  • Conduct performance evaluation [continued]

Enablers

• Fiscal Years 2023 to 2027
  • Governance
  • Change Management
  • Vendor Mobilization

Data

• Fiscal Year 2023
  • p-CHDCF, CA Core+ and Consistent Data Semantics
  • Data Matching
• Fiscal Year 2024
  • p-CHDCF, CA Core+ and Consistent Data Semantics [continued]
  • Data Matching [continued]
• Fiscal Year 2025
  • p-CHDCF, CA Core+ and Consistent Data Semantics [continued]
  • Data Matching [continued]
• Fiscal Year 2026
  • p-CHDCF, CA Core+ and Consistent Data Semantics [continued]
• Fiscal Year 2027
  • N/A

Access & Exchange

• Fiscal Year 2023
  • Consistent, Secure, HIE Exchange
  • Healthcare Directories and Resource Locations
• Fiscal Year 2024
  • Consistent, Secure, HIE Exchange [continued]
  • Provider Directories
  • Digital Identities & Identity Proofing
  • Healthcare Directories and Resource Locations [continued]
• Fiscal Year 2025
  • Consistent, Secure, HIE Exchange [continued]
  • Provider Directories [continued]
  • Digital Identities & Identity Proofing [continued]
  • Healthcare Directories and Resource Locations [continued]
• Fiscal Year 2026
  • Consistent, Secure, HIE Exchange [continued]
  • Provider Directories [continued]
  • Digital Identities & Identity Proofing [continued]
  • Consistent Patient Access
  • Healthcare Directories and Resource Locations [continued]
• Fiscal Year 2027
  • Consistent, Secure, HIE Exchange [continued]
  • Consistent Patient Access [continued]

Trusted Framework

• Fiscal Year 2023
  • Jurisdictional Needs Assessment [milestone]
  • Scalable Data Sharing Governance Framework
  • Industry-wide, Testing and Conformance
• Fiscal Year 2024
  • TEF development (contingent on PT support)
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]
• Fiscal Year 2025
  • Consistent Representation of Policy & Consent
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]
• Fiscal Year 2026
  • Consistent Representation of Policy & Consent [continued]
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]
• Fiscal Year 2027
  • Consistent Representation of Policy & Consent [continued]
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]

Outcomes

• Ability to import/export primary care data to, from and between EMRs
• Clinicians able to change EMRs
• Governance model established
• Vendor support services available to all jurisdictions
• National procurement framework established
• Change management program in place
• 50% of Canadians enabled to directly access their longitudinal record
• 60% of primary care physicians reporting ability to exchange patient summary record
• 70% of clinicians with EMRs enabled to send clinical summaries through a vendor conformed solution
• 75% of Canadians enabled to access their patient summary record
• Benefits realized:
  • Health System – $500M in improved interactions, effective use of ED, in-patient services, an reduction in duplicate tests
  • Canadians – over $500M in saved patient time
  • Clinicians – over $350M in saved time

Annex 3 – Headline common indicators

Annex 4 – Action plan

Saskatchewan continues to work hard at implementing innovations and reforms to ensure the sustainability of health services for its residents.

The federal funding^{Footnote 1} to be provided through the Canada-Saskatchewan Agreement to Work Together to Improve Health Care for Canadians (2023-24 to 2025-26) (i.e. the bilateral agreement) will accelerate and expand the actions and strategies Saskatchewan is already undertaking in the following areas:

1. A resilient and supported health
2. Timely, equitable, and quality mental health, substance use and addictions
3. High-quality family health services, including services in rural and remote
4. Electronic health information that is shared between health professionals and with

Saskatchewan's 3-year action plan focuses on initiatives and actions aligned with the shared health priorities identified in the 2023-24 fiscal year. It is anticipated that the federal funding for 2024-25 and 2025-26 will continue to be used to accelerate and expand on the provincial strategies and actions identified in 2023-24. Saskatchewan will work with Health Canada to make any necessary updates to the action plan following confirmation of planned expenditures through the annual provincial budget cycle.

Saskatchewan's patient first approach recognizes the importance of meeting the needs of the individual. The priority of the provincial health system is to continue to provide high quality health care for all its patients and families including, but not limited to, LGBTIQA2S+, rural and remote communities, official language minority communities, and First Nations and Métis peoples. This means being sensitive to, and responding where possible, to the specific health needs and challenges of different population groups.

With respect to Indigenous peoples, our government continues to build and strengthen partnerships with First Nations and Métis communities to meet the health needs of First Nations and Métis patients and clients.

We recognize that there is still a significant gap in the health status of Indigenous and non-Indigenous peoples in Saskatchewan. It is important that all governments work together with Indigenous communities and other partner organizations to close that disparity. This means working towards providing culturally responsive, inclusive, and safe health care services for First Nations and Métis peoples in Saskatchewan.

Currently, there are different tables where the province works or partners with Indigenous groups on health issues. Examples include:

• Prince Albert Grand Council (PAGC) on the redevelopment of the Prince Albert Victoria Hospital;
• exploring the option of a virtual care hub with the Whitecap Dakota Nation;
• Ahtahkakoop Cree Nation on the creation of an urgent care centre in Saskatoon;
• discussing with Cowessess First Nation the development of an urban health clinic in Regina;
• constructing a new Long-Term Care Home in the community of La Ronge, which will provide to residents across the north a safe and comfortable new space to live, close to home and family (the new facility will include a traditional healing space and a serenity room).

The Ministry of Health's budget for 2023-24 is an estimated $6.9 billion. The budget included key investments that align with the shared priority areas.

Health workforce and backlogs

1. An estimated $98.8 million government-wide investments distributed among the Ministries of Health, Advanced Education, and Immigration and Career Training, to continue advancing innovative health human resource solutions. Saskatchewan's Health Human Resources initiative is an innovative strategy that will recruit, train, incentivize and retain hundreds of health care workers and physicians in communities across the province.

A few examples of the actions being undertaken include:

• ongoing recruitment of Internationally Educated Health Care Workers (IEHs);
• continuing with the development of the Saskatchewan Healthcare Recruitment Agency (SHRA);
• supporting the hiring of new physician assistants;
• training seat expansion for high demand health occupations, including nursing; and,
• enhancing a variety of incentive initiatives, including Student Loan Forgiveness and bursaries.

Staffing stabilization in rural and remote healthcare facilities is a priority for the province. Long standing vacancies, staff turnover, under staffing and a lack of interest in full-time positions are contributing to service disruptions and inconsistent delivery of services.

Training seat expansion is also a key area of investment. Seat expansion will assist in reducing chronic and urgent vacancies in key health care professions driven by retirements, population growth, new investments in capital projects (e.g. Prince Albert Victoria Hospital) and to enable new government initiatives.

The Ministries of Advanced Education, Health, and Immigration and Career Training collaborate on health human resource (HHR) planning alongside key health care stakeholders to address provincial educational and health workforce needs. The ministries, along with the Saskatchewan Health Authority (SHA), form the Saskatchewan Health Human Resource Partnership (SHHRP) to align post-secondary education programs with health occupations in highest demand across the province.

Based on a supply and demand forecast conducted by the SHHRP, 18 health sciences professions have been identified and targeted for an increase in training capacity to meet the current and future labour market needs of the health system.

Initiatives supported by federal funding – Health workforce and backlogs

Annual federal funding of $61.7 million will help support targeted measures to avoid or reduce service disruptions, reduce reliance on casual, part-time, overtime and contract employees, and address issues within the acute care system.

• $27.1 million per year will support the acute and urgent care systems:
  • 64 permanent acute care/complex care beds, including 36 beds at Royal University Hospital (RUH) in Saskatoon, and 28 beds at Pasqua Hospital in Regina;
  • permanent staffing of a complex Alternate Level of Care (ALC)/Behavioural 36-bed ward at RUH which will help to ease the over-capacity situation and patient flow in Saskatoon by creating
  • capacity for admitted ALC patients with chronic medical and behavioral issues with the goal to expedite their recovery and transition them to a permanent home in the community;
  • additional beds at Pasqua hospital will help address overcapacity situations in Regina and also provide enhanced care for cancer patients who move to the new location within the same facility but now with improved infection prevention and isolation;
  • new annualized funding for 50.20 FTEs at Regina's Urgent Care Centre (UCC) – the UCC will provide patients with additional options of care, add to the existing spectrum of care services available to patients, provide another location of quality care for patients including both medical and mental health and addictions service provide patients with an alternative to the Emergency Department (ED) for urgent health care needs that cannot wait for 24 hour; and,
  • developing and operating a comprehensive pediatric gastroenterology (GI) program in the province – investment into the required programming, equipment, staffing (including physician coverage), supports the improvement of care for children's GI patients within Saskatchewan by improving staff recruitment (e.g. hard to recruit positions like pediatric gastroenterologists), reducing wait times, and minimizing the need for out of province care.
• $21.9 million per year will support the health system workforce:
  • rural and remote communities most at risk of disruption or experiencing chronic vacancies – over 200 new and part-time to full- time position enhancements have been successfully filled with a target to complete the target of 250 by the end of the 2023-24 fiscal year;
  • nursing and allied health profession students who will be in their final clinical for hard-to-recruit occupations – new training supports will help students who reside in communities where there are on-going service disruptions (i.e. rural and northern communities) and future infrastructure commitments (e.g. La Ronge long-term care, redevelopment of Prince Albert Victoria Hospital);
  • providing opportunities for local populations, such as Indigenous peoples to train and work where they live – partnerships with training institutes focused on indigenous peoples will be part of this strategy;
• $12.7 million per year will support recruitment incentives and training:
  • recruitment of internationally educated healthcare workers – two missions to the Philippines resulted in over 400 conditional job offers, and it is expected that an estimated 200 are expected to begin working in the province before the end of the fiscal year, with a number of these recruits being placed in rural and remote locations that support local Indigenous populations (examples of areas being supported are project coordinator/management, support for language examinations, stakeholder engagement, and evaluation of program success);
  • the rural and Remote Recruitment Incentive (RRRI), which offers a one-time incentive of up to $50,000 for new, full-time employees hired in hard-to-recruit positions for a three-year return in service – 246 RRRI have been awarded to date; and,
  • clinical placements that assist health care professionals in completing their education – increased clinical supports have been required to support the 550 post-secondary training seat expansion across 18 health training programs.

Mental health and substance use

2. In 2023-24, Saskatchewan is targeting an estimated $518 million to support the delivery of a wide variety of mental health and addictions Of the overall Health budget, an estimated 7.5 per cent is directed to fund mental health and addictions initiatives.

In October 2023 the province released a new five-year Action Plan for Mental Health and Addictions. The new action plan has three pillars of focus: building capacity for treatment, improving the system itself, and transitioning to a recovery-oriented system of care for addictions treatment.

Work will begin immediately on implementing a central intake system that patients can contact directly to refer themselves for mental health and addictions services. A central intake will make the system more accessible to patients and enable care providers to better coordinate care for patients across the system and throughout patients' care and recovery journey.

Recognizing that a cross-government approach is required to address mental health, addictions, and related issues, the new Action Plan includes collaborative initiatives between the ministries of Health, Social Services, Education and Corrections, Policing, and Public Safety, with work beginning immediately on the following initiatives:

• collaborating with the Ministry of Education on further expanding the Mental Health Capacity Building in Schools initiative to five more school divisions in time for the fall 2024 school year;
• collaborating with the Ministry of Social Services on providing wrap-around mental health and addiction supports for residents of the new supportive housing units as part of the Provincial Approach to Homelessness; and
• creating a Provincial Opioid Agonist Therapy (OAT) program to make addictions medicines more accessible across the province, including for patients in correctional institutions and after their release, in collaboration with the Ministry of Corrections, Policing and Public Safety.

More information on the new action plan can be found at the following link: Action Plan for Mental Health and Addictions

Saskatchewan recognizes the disparity of self-harm and suicide rates between First Nations and non-First Nations. In October 2022, the Federation of Sovereign Indigenous Nations and the Saskatchewan Health Quality Council released a report titled Self-Harm and Suicide in First Nations Communities in Saskatchewan. The report highlighted that:

• First Nations males die by suicide three times more than non-First Nations males;
• First Nations females die by suicide 4 times more than non-First Nations females;
• 25% of all First Nations suicide deaths are teenagers, compared to six percent among non-First Nations counterparts;
• First Nations males are hospitalized five times more than non-First Nations males for intentional self-harm;
• First Nations females are hospitalized nine times more than non-First Nations females for intentional self-harm; and,
• First Nations females under the age of 15 years, are hospitalized 10 times more than non-First Nations females (same age) for intentional self-harm.

Initiatives supported by federal funding – Mental health and substance use

Annual federal funding of $8.8 million through the bilateral agreement will help accelerate and expand provincial initiatives to support some of the province's most vulnerable citizens.

• $5.3 million per year will support addictions treatment for vulnerable persons:
  • the continued actions of the overdose outreach support teams – these teams connect with individuals recovering from an overdose or exposure to the toxic drug supply and assist in navigating them to services and supports which may include health services, housing supports, or income assistance;
  • increasing the number of addiction treatment spaces through the continuum of addictions care such as additional detox spaces, in patient and virtual addictions treatment and post-treatment housing and longer term supports (all spaces are open to all Saskatchewan residents regardless of race or where they reside) – as of 2022-23 there were 475 addiction spaces (the new five-year action plan includes a target of adding at least 500 addictions treatment spaces in communities across the province over the next five years)^{Footnote 2};
  • working with the Saskatoon Tribal Council and Ministry of Social Services to fund a new mobile service to support our most vulnerable citizens in Saskatoon who are typically homeless and suffering from an array of health issues (this service meets people where they are at, navigates them to care and transports to shelters as required to ensure their safety); and,
  • continuing to expand the Police and Crisis Team (PACT) initiative, adding another team each in Regina and Saskatoon (currently there are teams in Regina, Saskatoon, Estevan, Prince Albert, Moose Jaw, Yorkton, and North Battleford, along with a virtual team that partners with the RCMP to serve rural Saskatchewan) – PACT is a collaborative effort between government, police and the Saskatchewan Health Authority (SHA) to change the way mental health emergencies are handled in the community by pairing a mental health professional with a police officer, creating a team that is mobile and can help stabilize people experiencing a mental health crisis.
• $3.5 million per year will support children and youth:
  • expanding an innovative community-based rapid brief counselling program offered by Family Services Saskatchewan to children and youth, allowing children and youth to access services in real time either in person or virtually;
  • partnering with the Ministry of Social Services to create three new residential homes to support youth with significant mental health and addiction issues.

Family health services

3. The province is investing an estimated $338 million for health care infrastructure, equipment and IT infrastructure to ensure physical spaces and systems are in place and prepared to meet the needs of the province. Some of this investment speaks to service delivery in rural and remote areas, for example investing in hospitals and long- term care facilities in communities like Prince Albert, Weyburn, Rosthern, Esterhazy, Watson Lakes, Yorkton, La Ronge and Grenfell.

Saskatchewan also has provincial initiatives that:

• help seniors age within their communities and provide the supports that they need;
• enhance emergency medical services and provide reliable emergency healthcare services in all areas of the province, which helps to stabilize services in rural and remote areas;
• focus on public health, as well as primary and community care initiatives, for example:
  • enhancing services through HealthLine 811, including five additional virtual triage physicians;
  • increasing programming to reduce communicable diseases, including sexually transmitted and blood borne infections; and,
  • further developing the province's primary care strategy.

Initiatives supported by federal funds – Family health services

The province of Saskatchewan is committed to improving access and expanding primary care services for all residents by investing in team-based care in the community.

Annual federal funding $23.7 million through the bilateral agreement, will expand current provincial initiatives around primary and community care stabilization, and team-based family health services.

• $20.0 million per year will support primary care initiatives:
  • stabilization funding for community based fee-for-service family physicians that will assist in retention efforts targeted at the profession – this funding is a transitional measure that will build capacity for physicians to eventually adopt a new made-in- Saskatchewan family physician payment model based on blended capitation.
• $3.7 million per year will support team-based family health services:
  • the University of Saskatchewan's Chronic Pain Clinic (located in Saskatoon), which is a pharmacist-led clinic that focuses on chronic pain without interventional methods;
  • the Regina Chronic Pain Clinic, operated by the SHA, which can provide interventional treatments (e.g. nerve blocks, spinal stimulation) and other services for the growing list of patients with chronic pain); and,
  • the Virtual Triage Physician program (now called VIBEX), which is a service accessed through Healthline 811 and which redirects triaged calls to a physician – data shows that 68% of calls to the service were downgraded, which means being redirected away from the emergency department, 911 or care from a primary care provider, within four hours.

While physicians will continue to play an important role in the delivery of primary care, the health system should not rely on one provider group to meet patients' need for primary care. Rather, the health system has to adapt and use other providers to their full scope, in order to ensure prompt access to care from the most appropriate provider.

Modernizing health systems

4. Saskatchewan is investing $145.3 million in eHealth Saskatchewan, to help support the health sector's information technology operations and priorities. The province will continue the development of technology solutions, such as virtual care and MySaskHealthRecord, to enhance information flow and accessibility across the health system, improving the quality and safety of patient care.

Saskatchewan is beginning to develop a provincial digital health strategy to provide the required guidance to create a digital and interoperable wrap-around health care service and support improvement in the safety, effectiveness and efficiency of services offered to citizens.

The province is providing funding to eHealth Saskatchewan for:

• supporting IT security initiatives to ensure patient information is safe and protected;
• expanding the availability of personal health information to patients through the patient portal – MySaskHealthRecord; and,
• beginning a multi-year project to implement the lab information system into 13 midsize acute care sites to help ensure patients and providers have access to lab results in a timely matter, and reduce the risk of errors due to manual data entry.

Initiatives supported by federal funds – Modernizing health systems

Annual federal funding of $17.6 million through the bilateral agreement will advance provincial initiatives towards modernizing the provincial health system.

• $11.1 million per year will support healthcare IT infrastructure:
  • addressing information technology infrastructure requirements within eHealth and the health sector – this infrastructure includes upgrades to prioritized foundational equipment in the data centre as well as networking, core voice over IP (VOIP), and WIFI for clinical staff in select hospitals;
  • refreshing and expanding production data center infrastructure, network security and equipment improvement, enhanced computer room infrastructure in health facilities, and the refresh of Wi-Fi and phone systems in health facilities; and,
  • ensuring a stable information technology foundation which is critical not only in the immediate term, but also longer term so we are better able to proactively respond to the technological needs of the healthcare system – this means keeping technology up to date in order to be able to deliver new services, and is primarily for the IT hardware required to deliver healthcare.
• $6.5 million per year will support better use of IT systems:
  • the expansion of the Surgical Information System (SIS) / OR Manager Software to the 10 surgical facilities that do not currently use it, over the next three years. The Surgical Information System is Saskatchewan's centrally-administered system for collecting and reporting surgical data, which encompasses the network-based Surgical Registry (SSCN) as well as the OR Manager© suite of surgical management software. Providing access to OR Manager in all facilities supports surgical efficiency and improved scheduling and utilization of surgical resources, as users can easily monitor and improve operating room efficiency (for example by reducing the turnover time between procedures and more accurately scheduling the time required for each surgery). This investment in the Surgical Information System will support Saskatchewan's long term strategy to meet surgical demand by promoting surgical efficiency, reducing surgical backlogs and providing patients with more timely access to surgery.

Saskatchewan will not share any personal medical information with the federal government. This information is protected under The Health Information Protection Act and will remain so. It should be noted that the funding through this bilateral agreement is also not about creating a digital ID.

Saskatchewan has, and will continue to, report publicly on certain health system statistics, for example surgical wait times or the number of physicians in the province. This public information is available to all parties, including the federal government.

However, the province will not surrender nor weaken any personal health privacy rights with this new health funding bilateral agreement.

Dedicated funding for mental health and addictions services

Dedicated funding for mental health and addictions services from the 2017 Common Statement of Principles on Shared Health Priorities (CSOP) is now part of the Agreement to Work Together to Improve Health Care for Canadians. The federal funding has to date supported Saskatchewan in the following areas:

• Implemented addictions medicine services to support Prince Albert and the North;
• trained physicians on mental health to support their practice, along with training in Children's mental health;
• Community Recovery teams fully operational in eight (8) communities;
• Internet Cognitive Behavioural Therapy (ICBT) incorporated into SHA services and also delivered through the University of Regina;
• in collaboration with the Federation of Sovereign Indigenous Nations (FSIN), supported land- based healing camps for youth;
• 27 new positions created to increase access and capacity for children and youth;
• built mental health capacity in five (5) schools;
• created 75 supportive spaces created across Saskatchewan fully operational; and,
• Sanctum 1.5 10-bed supportive residential home, which offers compassionate and harm reduction care to pregnant women living with HIV and/or who struggle with substance abuse.

In the next three years, this funding will continue to support initiatives previously identified by Saskatchewan:

Improved access to community mental health supports

Better support, respond to and address the mental health and addictions needs of individuals through initiatives that:

• expand addictions medicine services in the central and northern regions;
• expand the use of Police and Crisis Teams (PACT) to pair police officers with mental health clinicians for calls related to mental health and/or addictions;
• support Community Recovery Teams to enhance the coordination and integrating of services for individuals with complex needs; and,
• implement a comprehensive and strategic approach for residential supports.

Enhanced delivery of evidence-based services

Enhanced access to services and outcomes through the use of technology that:

• expand access to digital cognitive behavioral therapy services, including new services for targeted populations;
• facilitate the implementation of a mental health and addictions electronic client records to ensure that client files are available regardless of location; and,
• support efforts to ensure that patient reported outcome tool is implemented provincially for adult, and child and youth outpatient mental health and addiction services.

Improved mental health and addictions services for youth and young adults

Expand capacity to deliver child and youth mental health and addiction treatments along the service continuum by:

• building clinical capacity to recognize, assess, and treat mental health concerns in children and youth at schools and in their community (e.g. developing community strategies for suicide prevention);
• targeting training program for physicians and pediatricians; and,
• increasing child and adolescent mental health specialists to provide intensive treatment and reduce waitlists/pressures.

Initiative	Dedicated mental health and substance use funding (2017 CSOP)			Total
	2023-24	2024-25	2025-26
Mental Health and Substance Use	$18.4M	$18.4M	$18.4M	$55.2M
Improved Access to Community Mental Health Supports	$11.1M	$11.1M	$11.1M	$33.3M
Enhanced delivery of evidence-based services	$1.6M	$1.6M	$1.6M	$4.8M
Improved mental health and addictions services for youth and young adults	$5.7M	$5.7M	$5.7M	$17.1M

Performance measurement and common indicators

Headline common indicators

The Federal government and the provincial and territorial counterparts committed to working together to measure progress using the eight common headline Shared Health Priorities indicators listed in the table below. These indicators were developed by Health Canada and the Canadian Institute for Health Information (CIHI).

The "Targets" described below represent the initiatives the Saskatchewan government is undertaking to improve upon the "Baseline" for each common headline indicator, and the "Timeline" represents the timeframe within which Saskatchewan is planning to achieve the "Target." The Headline Common Indicators are undergoing refinement by the Shared Health Priorities Advisory Council and the Expert Advisory Groups and may require adjustments to the identified targets and/or timeframes in the future.

Saskatchewan Performance Measures

Saskatchewan is responsible for the development of, and reporting on, performance measures related to the provincial health care system. On an annual basis the Ministry of Health is required to release a public business plan for the health system which includes specific performance measures; the measures are then reported in the Ministry's annual report.^{Footnote 11}

For the purposes of the Working Together-Shared Health Priorities bilateral agreement, the following have been identified as jurisdictional specific performance measures.