 Thank you everybody for joining us today. Before we get started I'll just give everybody a few reminder housekeeping items for the premieres at the table. If you wish to speak you have to press your button for your microphone to work. We have media on the phone line joining us today. If you have a question please press star one to enter the queue. Everybody on the phone and in the room will be limited to one question. We will start with questions in the room first and on the phone second. Please direct your questions to the premier that you wish to have a response from and clearly identify yourself and your outlet when you step up to the mic. I will now hand it over to Premier John Horgan. Thank you very much Lindsay. Good afternoon everyone. Thank you very much for joining us here in my hometown the traditional territory of the Lacongan speaking people the Esquimalt and song he's First Nation. We've had two and a half days of vigorous discussion about all of the things that bring us together in Canada as well as the challenges we face region by region province by province community by community. It has been an invigorating time when you have 13 Canadians coming from different perspectives different places all with a common goal and that is to lift up the citizens in their communities to ensure that Canadians can have the best possible outcomes during the very challenging times we've all been through. During the COVID-19 pandemic this group the Council of the Federation met over 40 times as premiers to discuss the challenges we were facing in our communities as a result of a global pandemic throughout that time we met with the federal government 36 times and the collaboration and cooperation was quite frankly unprecedented in our history and the outcomes for Canadians were also unprecedented although we were facing the same challenges other communities were around the world outcomes for Canadians were better because we were working together using our public health care system to protect and preserve the well-being of our citizens but now that we're coming out of the pandemic and looking forward we see more challenges climate change rising cost of living and affordability issues with respect to inflation as well as a number of other concerns that we discussed over the past two days. Although Michelle ago and I have been regularly briefing you on our discussions with respect to health care and outcomes for Canadians and how we need to invigorate and revitalize our public health care system by focusing on a new and a new reimagining of how we can meet the needs and expectations of our communities we also spoke about the challenges of strengthening our supply supply chains and bolstering our labor market addressing climate change of course enhancing our energy security and food security as well as struggling with the challenges of mental health and addictions in communities across the land and lastly we had a very good discussion led by our territorial leaders on the challenges of Arctic security and Arctic sovereignty all of these issues are on the table all of these issues are facing people across the country and as leaders it's our obligation to find the best way forward with respect to affordability and inflation all of us are coming at this with different perspectives different approaches and I think that's the strength of the country historically and it's certainly the strength of the country today we have a diverse group of political perspectives here we have linked linguistic differences we have backgrounds cultural backgrounds that are different and we're able to take all of those differences and celebrate them and remember and reflect upon how fortunate we all are to have our Canadian citizenship but the number one issue for us for the past five years and in fact even before I joined the council the Federation is public health care we see the strains and cracks in communities whether it be primary care whether it be acute care whether it be our long-term care infrastructure we see new and emerging technologies that are costly and requiring more investments than ever before we've seen of course a rise of awareness and understanding of our need to address and tackle mental health and addictions as well as of course new pharmaceutical and therapeutic solutions that are also costly and require major investments if our citizens are going to benefit from the innovation and the dynamism of those working in the health care sector and most importantly speaking about those people we remember all of us celebrating every night at 7 o'clock by coming out onto the street and banging pots and sending our gratitude to frontline workers who are going and risking themselves and their families to keep the rest of us well and we enjoy some we enjoyed and embraced that initiative but it was symbolic we need now more than symbolism and that's why we've been calling on the federal government to come and join us to sit at a table to talk about these pressing issues because Canadians expect nothing less from us and with that I welcome any questions from you and all of my colleagues are here prepared to answer any issues you want to bring up within the context of those we've discussed and potentially any other so you believe are relevant to the council of the federation thank you premier as a reminder to those on the phone line please press star 110 to the queue first question Richard Zestman global news premier Horgan you spent months leading up to this meeting speaking about the importance of health care you come here and you don't get anywhere on health care you have a final communicate that doesn't even mention health care and I understand you had information out this morning how disappointed are you that we're no further ahead now and I know you spoke to doctors and nurses who proposed a number of things that did not need new money licensing issues different payment structures where are we at with that even though you weren't able to get somewhere on money well first of all we issued a communicate this morning on the number one issue so to suggest that we didn't raise public health care in the final communicate I think is a paper processing issue on your part not ours we were out this morning talking about the results of our discussions yesterday and if you didn't get a copy we can certainly get that sent to you but we did talk about a range of issues best practices myself and my colleagues have been working in our own communities working with stakeholders working with patient groups working with doctors social workers nurse practitioners registered nurses the whole continuum of health care providers looking for solutions to the challenges ahead of us and although there are issues that we can address that don't require an initial investments or additional investments from the federal government such as licensing we do in the final communicate talk about our regulated professions and how we want to see more labor mobility within the country and also with with those who have credentials foreign credentials we want to see those recognized more rapidly and we're working on those strategies all the time but at the end of the day what we need to do is infuse some resources into the system so that we can get the outcomes that people want to see and that is having a national human resource strategy so that we don't find ourselves poaching from each other and outbidding each other to find the health care professionals we need to provide services in Canada from coast to coast to coast that's why we come together that's why we have a federation so that we can have national standards and national practices but at the end of the day the jurisdiction for delivering the services rests with the provinces and historically that exchange of responsibilities was we deliver the services and we share the financing of those of those services at a 50-50 rate we're now down to about 78% on the on the provincial side 22% on the federal side and that's just not acceptable we don't want to quibble about the money we want to get at the table to talk to the federal government if they're not acknowledging and recognizing the crisis in communities across the country they're asleep at the switch quite frankly and we invite them to come and talk to us about how we can work together to get the outcomes Canadians deserve next question bender sergeant CTV Premier Horgan just want to ask you with regards to getting the federal government to the table it appears that you've failed to do that despite the consensus with the premiers right now given the comments that you've heard from federal ministers do you feel any hope that you're a little bit closer even to getting the federal government to the table well I've sat down with the Prime Minister last November and I had just come out of surgery I was facing 35 rounds of radiation treatment for throat cancer and I was vulnerable as a as a human being and as a Premier and the Prime Minister and I had a candid and frank discussion about the importance of making sure that as we go forward we're working together to address the challenges of patients and those that are accessing our health care system the Prime Minister gave a commitment to me that he would task his ministers to meet with us and we as a group agreed that we would look at a diverse group of Premiers we selected Premier Fury from Newfoundland who's a surgeon Premier Premier Mo from Saskatchewan who was the past chair of the Council of the Federation that coming from the Prairie and myself as a representative group of Premiers to sit down with the appropriate federal ministers to set the table for a discussion about how we go forward that was eight months ago and we started with a meeting in January where we reaffirmed the need to have a face-to-face meeting and after that it got quiet we had a couple of phone calls with the Minister of Intergovernmental Relations and that was it I got a phone call from that same minister on Sunday morning Sunday morning the day we started this conference asking how things were going and I gave him a candid response to that question and here we are Next question David Cochran CBC. Hi there Premier Horgan and any other Premiers would like to answer this. Federal Health Minister DeClo was just on power in politics and was asked about your request to have a first ministers meeting and instead what he said needs to happen is a conversation about results that would be achieved before you can talk about money and his view is that that is a conversation that needs to happen at the health ministers level to get that sorted out before you can have a first ministers meeting to talk about money so I see some head shaking I wonder if we can get some reaction to that well again we're not here to be fodder for power and politics but although it seems to me the federal government wants to negotiate through your program so if that's how we're going to roll I guess we can do that that's firstly counterproductive and secondly again I use the word disingenuous Mr. DeClo has had an opportunity to have those discussions with us for eight months and to now as we gather here in Victoria to talk about how we go forward to say I got an idea why don't we talk about outcomes that's what we told them eight months ago we shared a basket of initiatives with them and nothing came back nothing came back so with the greatest respect to the federal ministers who are now suggesting that everything is fine go and talk to human beings go and talk to patients go and talk to health care providers and they'll get a different message we are echoing what people are telling us in our communities across the country and I welcome my colleagues to respond to this because I feel that I'm holding them back from what they really want to say Francois do you want to start anybody else go ahead sorry well first of all thanks for the question I want to start off with thanking Premier Horgan for hosting us he's been incredible he's been incredible leader for for BC in the entire country on many issues but especially health care so so thank you you know as Premier Horgan said it's pretty disingenuous when you have the minister come out and say you know well here are a few ideas and by the way handed over to your ministers of health it's just one request come to the table come to the table start the discussions we've been asking for this for for years all the way back to when I first first got elected so it's unacceptable and we need to sit down and see the investments tell that to the patient in Ontario that's waiting for hip replacement or a knee replacement or as simple as cataracts or the backlog surgeries that we face every single day right across this great country from coast to coast to coast you know that's what we we need to talk about you know people don't care where the money's coming from they want action they don't want to see a backlog of surgeries which which majority of us are facing come to the table we'll meet you anywhere anytime all 13 of us will put our schedules aside to sit down and start the discussions but to sit back and communicate through the media it's really insulting to all the people of Canada and insulting the 13 premiers I would just echo on the results piece in particular we're we've been very open that we there's none of us here who wants worsening results in Canadian healthcare what we're asking and I think it's reasonable and I think it's demanded of Canadians is an opportunity to use this time of disruption which I think we can all recognize we're in to reinvent and reimagine a modern Canadian healthcare system I think we need to have a mature debate about where that goes and there's been some commentary about the 22 versus 35 and the calculus surrounding it but that debate needs to happen at a table and all of us here today are committed to that table an open collaborative discussion that Canadians frankly demand and more importantly deserve I've been on the other side of a gurney I've had to cancel surgeries I've been dealing with nurses who have worked 24 hours in a row seen nurses leave the or crying because they can't get to a family member's wedding I've lived it the time has come the pandemic has heightened it but now was the time for all levels of government to work in a collaborative way to modernize the system to deliver Canadian level all of which we celebrate around the world I've operated around the world we are known around the world for our standards of care we can do it but we need to do it together and exchanging rhetoric in the media is unfortunate but we have to come together collaboratively in order to save the Canadian healthcare system I can go maybe we are here 13 premiers who say the same thing we cannot afford anymore to finance 78 percent of health care expenses healthcare expenses in Canada right now it's over 200 billion dollars a year so what we're asking for is to meet the prime minister that the premiers meet the prime minister we're not asking that he delegates that to a minister of health and our minister of health we need to have a meeting it's a real problem it's the most important problem in Canada so I don't understand why mr. Trudeau doesn't want to meet us and it's a bit insulting to send mr. Leblanc or mr. Declau answering our request and I just I just want to add because I think Andrew hit a key point everyone in this room and everyone across this country understands that we've been through an unprecedented time unprecedented in time in our history internationally much less here in Canada and in a time of disruption that's when innovation happens and you don't see that innovation by ignoring opportunity to engage you you take advantage of innovation by engaging and it's completely absent right now and that's that that's the tragedy it's sort of sadness not anger that we sit here today we have work to do we have ideas the federal government might have some ideas as well let's exchange views let's talk about how we get out of this making Canada a better place and that won't happen by exchanging barbs through the media next question please go ahead hello michelle sabade la presse canadine d'abord monsieur le go pour y vous répéter cela en français oui on est actuellement 13 premières 13 premiers ministres 13 provinces et territoires qui disons la même chose qui demandons la même chose on a besoin d'une rencontre avec le premier ministre du Canada pour discuter du financement de la santé actuellement on dépense plus de 200 milliards de dollars par année dans les différentes provinces pour la santé les provinces et territoires p 60 18% du 200 milliards on est plus capable de continuer à payer 78% sans que le message est clair mais sans que le message est important il me semble que monsieur Trudeau devra accepter nous rencontrer et c'est un peu insultant de déléguer les messages via monsieur du clou le ministre de la santé fédérale d'abord comment se fait-il qu'il y a un ministre de la santé fédérale alors que c'est un champ de compétence des provinces et des territoires c'est le premier problème mais c'est très insultant que monsieur Trudeau refuse de rencontrer ses vis-à-vis sorry next question please beaucoup donc je vais poser ma question en français mais mr organ i would like to you to answer it also in English donc monsieur Kenny nous a dit tantôt en français que l'alberta serait absolument prête à offrir la garantie de ne pas réduire ses dépenses en santé en échange d'un financement si c'est une condition du fédéral donc j'aimerais savoir si d'autres provinces compris le Québec sont prêtes à donner des garanties ou accepter certaines conditions pour le fédéral on le dit puis un des problèmes qu'on vit c'est qu'actuellement les dépenses en santé augmente de 5 à 6 pour cent par année même si on veut offrir le même niveau de service à cause de l'impact du vieillissement de la population par cause des nouvelles technologies donc je pense pas qu'il y a personne ici là qui veut réduire les dépenses de santé faut continuer les augmenter on s'est fait aider depuis trois ans par le gouvernement fédéral avec des dépenses non récurrents mais que fait-on dans les prochaines années si on a pas l'argent de du gouvernement fédéral c'est ça là qui est la question no way from the Toronto star my question is for premier Doug Ford you came here looking for some consensus and support on the issue of immigration especially as it relates to labor shortage how did the discussions go and you feel you got the support you were seeking is the statement that been put out is it strong enough thank thank you for the question there was a consensus and you know it's amazing you were short 378,000 jobs right right here to be filled by these companies that are in desperate need when I was on the campaign trail I went from one end of our province to the other and the number one sign I saw not election signs it was help wanted signs in small businesses medium businesses large businesses and all you have to do is go to a restaurant and you ask the owner of the restaurant their short staff ask your own employer every company out there needs people so we're willing to help the federal government but we need their help right now next question please go ahead they're in the prince radio canada j'ai une question for Monsieur le go what if other premieres want to answer after that they can par rapport à l'entrevue de dominique le blanc qui l'accordait par une politique se fait référence au fait au chèque finalement qui ont été remis au québécois en disant si on transfer de l'argent faudrait pas que les provinces réduisent leur financement santé et en quelque sorte détourne l'argent la mettailleur est-ce que vous êtes sensibles comment avez vous réagit bon d'abord c'est temps temps de dire on va répondre aux commentaires du premier ministre pas de ses ministres bien bon rappelons nous que le 500 dollars qu'on a donné au québécois c'est un montant ponctuel non récurrent l'on parle de payer pour des infirmières embauchés du personnel de façon récurrent donc je sais pas si monsieur le blanc fait exprès ou si comprend pas il y a une différence entre un montant ponctuel non récurrent puis des besoins d'augmenter les transfer en santé de façon récurrent à long terme pour entre autres financé de la main d'oeuvre donc je pense qu'on mélange deux choses là actuellement je pense que monsieur le blanc comprend très bien que ça rien à voir le commentaire sur les versements ponctuel oublions pas que de façon générale le québec au québec les québécois pay plus d'impôts dans les autres provinces donc aussi les comptes de ça et moi je dirais que il ya deux deux urgences au canada maintenant l'urgence du de l'inflation le coup de vie et deuxièmement l'urgence dans le système de santé il faut que les gouvernements s'adresse les deux urgences et ça c'est une demande de la grande publique c'est ce que nous faisons chacune dans notre propre voie nous avons les politiques particulière pour s'adresser le coup de vie en Alberta on a laissé tomber le taxe sur le sens mais en même temps on a on a augmenté deux milliards d'alarmes au budget du santé puis comme françois a dit nous espérons que les crises de coups de vie de l'inflation c'est quelque chose de court terme mais évidemment les crises dans le système de santé des capacités qui a été révélée pendant la pandémie et quelque chose à long terme et je ne sais je ne comprends pas pourquoi a-t-on ne peut pas s'adresser avec nous autres les deux crises juste in English I would say the question was about mr the minister of long saying you we provinces are addressing cost of living issues that means they're wasting money not putting on health care but they're in fact two crises major crises and priorities in the country right now inflation in the cost of living and health care capacity and as leaders we have to address both that's what we're all trying to do in our own ways in Alberta we've done it by dropping the fuel tax but also on the other side for health care increasing the budget there by two billion dollars we all hope the inflation crisis is a short-term one the health care capacity crisis is a long-term one and the federal government simply has to be part of the solution and I would add to to françois on Jason's comments that that we're talking about long-term sustainable predictable funding so we can build out the infrastructure that's needed in terms of our post-secondary institutions to train the next generation of health care workers ensuring that we have access through immigration like all of the questions that are coming really come back to the one thing providing services for Canadians and if we're able if we're going to do that we can't do it with one time funding the issues around inflation and fuel prices and the impacts on on pocket books are issues that we hope as Jason said are temporary the challenges in health care are going to be long term and we need to start working on it right away with a plan that doesn't just have one off funding which is the preferred model for the federal government but a sustained funding over time so that we can build out that infrastructure which includes of course people to provide services to other Canadians next question please go ahead Bonjour Nicolas Lachange, journal de Québec, journal de Montréal Monsieur Legault, une question, mais pour vous, mais ça pourrait être aussi pour vos homologues. Monsieur Kénie a présenté tout à l'heure une proposition sur le libre échange qui semble aller beaucoup plus loin qu'est-ce qui est présenté dans le communiqué actuel. Qu'est-ce que vous pensez de cette proposition là, notamment sur les reconnaissance professionnelle? On est tous d'accord les premiers ministres des provinces des territoires pour faciliter les échanges entre les provinces. On voit par exemple avec les États-Unis qu'il y a de plus en plus de protectionnismes aux États-Unis donc c'est une raison additionnelle pour que les provinces et les territoires facilitent les échanges commerciaux, facilitent aussi la reconnaissance des acquis pour les personnes qui changent de province ou de territoires donc on est tous d'accord qu'il faut en faire plus de ce côté-là. Étant donné que j'ai été mentionné dans la question, je souligne que dans la déclaration, dans le communiqué, il y a un engagement pour accélérer la reconnaissance des titres professionnels partout au pays. Nous l'avons fait dernièrement avec une nouvelle loi sur le main-d'oeuvre qui reconnaît effectivement sur le champ les titres professionnels des Canadiens qui déménage en Alberta. Mais deuxièmement je suis très reconnaissant que tous les premiers ministres étaient d'accord pour donner une direction à la table de concertation sur les réglementations de la fédération pour accélérer le travail, pour développer un modèle potentiel, je traduis, pour reconnaissance mutuelle des réglementations avec une option d'une liste négative. C'est exactement ce que j'ai proposé dans la conférence de presse, c'est ce que nous avons lancé avec l'étude et j'aimerais remercier toutes les premiers ministres d'être d'accord de ce dégât. Thank you. This question I think was touched on in French and I'll direct it towards Premier Horgan but if anyone else would like to add. Premier Horgan you said earlier today that any health transfer money would go into a pot and it's the province's jurisdiction to figure out where that goes to support public services and I'm wondering what if the so-called conditions that we've been hearing about from the federal government relate to spending the money specifically on health care some of the priorities that you've identified what is your understanding of the possible conditions and are you concerned that that's a sticking point in coming to the table? Well thank you for the question and this is this is the challenge if we have to engage with our federal counterparts through media interviews I've written to the Prime Minister in December no response we sent a package of principles that we felt we would guide a discussion no response and now it's well we want you to spend it on specific things and we're fine with that and what we all agree on is that there are a range of issues that are affecting the health care delivery across the country but there's different nuances and emphasis depending on where you live demographics have a lot to do with that for example where you have an aging populations long-term care is a higher priority than primary care might be and and so in Alberta where there's a younger population the needs of the health care system are different than they would be in British Columbia or other provinces that have aging populations so that the whole point of us being responsible our jurisdiction to deliver the services is we're better place to make those choices based on the needs of the communities that we represent therefore we've had historically a transfer of resources from Ottawa which we then distribute within our health care budgets and and I don't want people to I don't certainly don't want the federal government to take a clip from a news conference and say see they're going to use the money for something else we get money in and we send money out to provide services for people and the number one cost driver for our budgets the number one issue for our citizens is the delivery of health care services so it there's no debate about what we would do with a health care transfer except what the emphasis would be province by province by province by territory and that depends on what the circumstances are whether you have a sufficient number of primary care providers or you need more acute care providers or it's another infrastructure piece that you want to invest in we believe that we have the responsibility to make those decisions we believe the federal government has responsibility if we have a national program guided by the Canada Health Act then they certainly should sit down with us and we should engage with how we best deliver those services for the citizens that we all represent I would just add that Premier Horgan's done an incredible job of communicating this as well and I think it's important to understand and I think Canadians understand that that's a bit of a false equivalence especially around when forcing a choice between cost of living and health care the next thing will be health care versus pavement that that's a false equivalent all we just want to get to the table to talk about the funding to move beyond the conceptual framework into a more substantive discussion collaboratively with our federal partners to achieve these goals and I just would reiterate there's none amongst us who wants outcomes in health care to worsen we are committed to improving the system we're committed to improving outcomes and results for patients across the country and so I don't really see a big gap there but I do see a debate developing that I do believe is false. Next question Andrea Wu. Hi there. So Ottawa has indicated that it wants to see some accountability for any additional funds that Canadians want to know how this money is going to be spent. Premier Horgan in your remarks this morning you said that provinces and territories are accountable every day through their legislatures that the federal government is creating a problem that doesn't exist but during the COVID-19 pandemic we saw an auditor general in Alberta saying that because of poor record keeping we have four billion dollars meant for COVID-19 initiatives and we don't know what that actually achieved in Ontario two hundred and ten million dollars that was meant to go to small businesses went to those that were not qualified. How did the Premier's respond to that? Well I'll start and I'll certainly let the Premier's that you identified take a stab at it as well. We are accountable to the citizens that we represent. The federal government is not a superior order of government it's not a better order of government it's an equal order of government and we'll take no lessons from the federal government in fiscal probity. I mean I think there's an issue or two over time that auditor generals in Ottawa have highlighted or the Parliamentary Budget Officer has suggested were a grotesque or egregious expenditures so point made federal government if you think that you're somehow superior to us in terms of our ability to manage these issues but none of that matters to the people who are waiting for a hip replacement none of that matters to the people who are in a hallway because the ERs are crammed because they're not enough staff to move people through none of that matters none of that matters if you are on a cancer wait list and you can't get access to the chemotherapy or the radiation need so it's all again well and good for people to sit in Ottawa 3,000 miles from where we are today and suggest that they somehow are superior in managing the finances of the country than we are in managing the finances of our provinces we are accountable every day to the people who elect us and they are the ones that make a determination about our effectiveness or lack of effectiveness on election day and that is the ultimate accountability the federal government is in Ottawa telling us that we're not doing a good enough job but they're also saying we don't need any more resources because there's plenty in the system you can't be both of those things at the same time and we need to sit down and stop talking between this table and the federal government through all of you good people who've come here to transcribe our words and send images across the country Canadians don't want that they want us as adults to sit down and figure out how we deliver the services they demand and of course they pay for the money in Ottawa isn't Ottawa's money it's Canadians money and guess what it doesn't come from Ottawa it comes from provinces we're asking for some of it back to provide the services that Canadians expect us to deliver and I'll let Doug and Jason take on there first of all every dime of what we spent on extraordinary investments during the pandemic was for public health and all of that is obvious just like every other province all of that in due course will be fully public and review can be reviewed by the legislature the public auditors and others but it's true that in the midst of the pandemic I like I'm sure every other government our focus was just responding in real time to the emergency and not clearing through mountains of paperwork we there's no doubt about it we we cut the normal corners on procurement because if there were days remember we were on on calls that as a group early on when provinces were day days from running out of the critical equipment so we were all doing whatever it took to get warehouses filled with ventilators and PPE to get additional medical supplies medication and and everything that was required all across the system all of that will become evident we certainly have the same kind of generally accepted accounting principles as all governments do all of it fully transparent reported to the legislature reported to the public we've actually increased funding for the Alberta Health Quality Council which measures health outcomes we brought in Ernst and young to do a performance review of Alberta Health Services to find efficiencies and so forth and I don't have any objection to sharing all of that and more with the government of Canada I think that's actually quite reasonable and in the last Health Accord 2005 there was a reporting obligation for provinces to report back I think that's that's quite reasonable but how do we know that that's what they want when they've never actually sat down and said it to us we will take one more question in the room Shannon waters BC today don't get to do that very often thank you Tara I'll direct my question to Premier Horgan but if any of the other premiers want to chime in feel free you've mentioned a couple of times in these past couple of days the need for a national framework to prevent provinces from having to compete with each other from poaching from each other when it comes to recruiting and retaining healthcare professionals and I'm hoping you can provide some details on what that looks like presumably training and recruitment would be priorities there but I'm curious as to whether that also involves a triage system or prioritizing staffing needs and so is that something you have some specific ideas on at this point or is it just an issue you've identified that needs to be discussed with Ottawa at this time right it's the latter we have been appealing to the federal government to sit down with us so that we can establish frameworks for engagement across the country from coast to coast to coast we need to do that so we can all have comfort that we're I mean all of us have been in unison on this question for at least the five years I've been here Sandy's been here for six and this was the issue when I arrived and it's the issue as I as I leave and the federal government has refused to come and sit down with us and engage with us about what they believe the best way forward is beyond power and politics and so if that's if that's the state of our Federation then I'm not as optimistic as I was when I got up this morning I'd like to think that as we look at the challenges that we all face in this unprecedented time I I think we need to harken back to that as Jason said 24 months ago we were collaborating in an unprecedented way what Ontario required the rest of the country was working to make sure that we could deliver I know that one Jason and Alberta had a backlog of personal protective equipment that we were able to distribute across a surplus of materials that that he welcomed the the rest of us to access a Premier Fury and his spouse traveled to Ottawa as physicians to help out I mean there was unprecedented collaboration and the federal government was right there and we applauded that engagement it was an unprecedented time for all Canadians but it was also an unprecedented time in our Federation and now eight months later we're exchanging notes through the media I you know where'd the love go you know I mean everything was so fine and then it wasn't I mean this is it's it's vexing that we could have made so much progress together and now when we all recognize that the cracks in our precious health care system are there for all to see most importantly our citizens who want services when we turn to our partners our allies and say hey let's get together and figure this out they go now you got enough or you're going to waste it or maybe we can't talk to you right now there's something else going on what could be more important for the intergovernmental relations minister than to relate with the other governments of Canada is there anything else on his docket beyond the 13 of us I wouldn't think so but here we are I just like to specifically comment on the question with respect to mobility across jurisdictions I think that as we've said many times here today this moment of disruption caused by the pandemic creates an opportunity to look at the practice of medicine very differently and we know new generations like to practice differently than old the old paradigm of hanging a shingle and being the only physician or nurse in a community that's just not going to fly anymore in the longer we hold on to the rope that romantic notion the harder it is going to be for the system and more importantly for patients so when looking at mobility across jurisdictions I think it's a creative way to unlock new potential of employment new potential of service across the country because I know there's barriers when you're a physician for example to practice in other areas be very cool and interesting to do a locum in BC you know and practice do some total hips and in British Columbia but there are barriers to that significant barriers and so if we look at a national strategy and to eliminate those barriers and allow physicians and nurses to cross jurisdictions I think that's a creative way in using that in combination with new technologies that we've harnessed during the pandemic to provide services especially to our rural communities so I think that this is an opportunity one that can't be lost in the rhetoric that unfortunately seems to be evolving can I just add John I I take my time back to being a staffer working for premier bins when the council of the Federation began and at that time premiers were meeting trying to get a meeting with the Prime Minister to talk about more money for health care so we all understand I've talked to many of you we all understand that there's a certain frustrating romantic dance in this whole thing but I do feel that the factors are different now it's changed that like we're in a situation that we can't go on with this silly back and forth I'll talk to the media you say this I say that will frustrate the premiers the premiers will respond and we'll do this silly dance the factors have changed so much that we need to put aside this silliness and and as we did through COVID I mean we 26 or 27 meetings with the Prime Minister we talked weekly almost to get through a situation of challenge that the country needed us to come together to do we're in that now with the overall delivery of health care and I think it's it's incumbent upon all of us it's incumbent upon our colleagues in Ottawa to put aside some of that silliness let's not let that be the norm again let's get back to do what Islanders and in my province and Canadians across the country want us to do is let's get some solutions to some of these challenges why do we want to mess around with this little dance let's let's get the work done and that's I think that's why you're hearing the frustration from from this table but I think you know Canadians are I'm assuming quite frustrated with it as well I would like to add something to this conversation in relation to the people and the nurses and the health professionals that are in the hospitals Premier can talk directly about the surgeon and the family physicians and and what that means and how innovation has to change in the system but we met we met this week with all of the nurses with the nurses union across the country and you know we've heard many stories about 24-hour shifts and the concerns about being in the ERs and safety I think the opportunity is how do we address those concerns that are every day simple things like like the scheduling you know like they they're getting burned out they can't even have flexibility in the scheduling I think there's a there's there's money needed to have a continuation and a better health care system but there's also an opportunity to engage employees right in the front lines in the hospitals that are delivering the service nurses are saying we need more nurses yes we do but we need innovation we need better health care that's delivered every day by the people that know it best and I think it's time we listen to those people and got their got their information first hand of how we can change and when we talk about interaction between provinces it's where is but where are best practices and how do we not duplicate services but how do we compliment services and I know during COVID in the Brunswick we have two health care systems vitality and horizon but they we work together like never before to deliver health care in the province and we learned that we can do that better together than we could as two independent so yes we have two systems but they can complement each other in their service delivery and I think what we're seeing is we can broaden that between provinces and we've had that discussion in Atlantic Canada so the opportunity for us to be better at what we do is all part and parcel to more money to help us there but we can deliver a better result with people being part of that solution we will now go to the phone lines first question Dylan Robertson win a pig free press from your hork and you're coming away from this one it was no visible movement from Ottawa the health transfer if anything there's been more pushback from Ottawa now since your initial demand in 2020 and you don't seem to have a lot of leverage Ottawa says that there needs to be things attached to the money that it's giving but your statements today don't show an openness to conditions and you actually compared that this morning to a surf relationship so I'm curious to know if you feel that the strategy is working if you're coming away from the summit arguably further behind for a week ago and also a premier stuff then would like to weigh in on that well I'll start and Doug and Heather can follow in terms in terms of leverage this is this isn't a wrestling match this is this isn't a battle of titans this is partners collaborating to deliver services for our fellow citizens this is not this is not a one-upmanship effort here this is about let's get together we've got a whole bunch of people here that are delivering services in different and diverse communities we have different political perspectives that again we're sitting down together to figure out how do we go forward and we're looking to our ally our partner in Ottawa saying hey how about it and we get back this well you know we're just not prepared until there's conditions what conditions tell us what these conditions are well you won't give tax cuts to your citizens well we can walk and chew gum at the same time we have multiple responsibilities within our jurisdictions and the primary one is delivering health care services but we still have to keep in bc the the ferries have to keep running the the highways have to be maintained the schools need to be populated and built and all the other things that we do in a in our society to be one of the most desirable places on the planet to be it's not about well if you don't do it our way it's not going to happen we need collaboration cooperation and that's what we've been doing for five years and the federal government just needs to join us and if they have ideas and and they involve conditions if they involve best practices if they involve any number of things happy to have the conversation we sent at their request a series of initiatives that we wanted to pursue and we got zero back I don't know what to say about that you can't we can't negotiate with ourselves someone asked me the other day well I want to know specifically what you're going to do with the money so why would I engage in that when I just need to deal with the money I have and the services that I need to deliver when we get to a place where we're talking about how we're going to distribute the money we can have a discussion about where it's going to be spent but it's counterproductive to say before I give you anything you need to tell me exactly what you're going to do with it because this is a dynamic situation we're in and it always has been and it always will be and it wasn't a problem in the past for Canada to say as they did in 2004 let's figure out a way forward and they tried to do again in the last decade it is 2022 people are living longer services are getting better we're more sophisticated and more innovative in the delivery of health care services and that costs more money this is not Mayberry anymore we're not in Kansas anymore it's Canada 2022 we have a publicly funded health care system that needs an injection of cash and we need to talk about how we do that come on to the table a lot of when we're happy to do that just just briefly Dylan thanks for the thanks for the question and you know this is and you know I've talked about this before this is the number one issue one of the most important issues across the country right now and all we're asking for is for the federal government to come to the table we're not afraid of things like accountability to our citizens we do that every day we're accountable every day and that's been mentioned here today we're not afraid of getting better results we want to get better results for Canadians when it comes to health care and so those are the issues that they seem to be talking about as reasons that they don't want to sit down with us at the table and to me I just think that's really disappointing I think Canadians really want us to be working together in different levels of government taking a more collaborative approach to these things and I can just say just quite honestly from my perspective and and and from Manitobans that's very disappointing they want to see us working together I hope that they will put whatever it is aside just come to the table so we can start to have those discussions and I just want to intervene and say um I'm not afraid of accountability I'm from the Northwest Territories we're not afraid of accountability we have open books we get out all the time come and see what we're spending no money but the needs of each jurisdiction are different Canada is diverse and we're well known for that and appreciate worldwide for that diversity in the Northwest Territories if if all of the money was to go for example into long-term care we care about our elders and our seniors dearly but we have communities in the Northwest Territories because of the short staffing we don't have a health centre we've closed down the medical care facility in communities could you imagine living in a hometown and if you have an emergency something happens to your child to your parent to yourself that you can't even get a service so that is what we're talking about we need the flexibility we're I'm willing to show you where we spend our money but don't tell me that I have to spend it all in long-term care when I don't even have a doctor and a nurse in our communities so every jurisdiction is different we all have different needs and we're all accountable there's not one of us that doesn't have to open our books but the point is is that if if you're not even at the table and talking to us then you can't even hear those concerns and all we're asking for is come to the table hear our concerns work with us thank you thank you and I guess what I'd say is I think you're saying it's it's pretty unanimous here you couldn't there's not a there's not a community in this country that you could go to and stop somebody on the street and ask them what they think of the state of health care you get the same answer in every single community we have a lot of work to do in health care and all the only thing we're asking for is is the federal government to come and talk to us about it and if they don't want to do that because they're afraid it's going to cost them money well then there's there's a lot of big issues that we need to get through starting right there but I mean if they want to ask us well what are the outcomes we're focusing on I can tell you right now in Nova Scotia there's there's nurses being called in from vacation because they're needed on the floor those are the outcomes we want to fix that's what we want to talk to the federal government about if they want to talk to what are the outcomes that we're going to address you know I'm you know we shared stories today about emergency room physicians who are just burnt out and exhausted and are afraid they're going to make a mistake at work because they're tight they need help they need our support those are the outcomes that we want to address and we just want to talk to the federal government about it I can tell you there's nobody up here who's trying to scrimp on a health care budget and divert money somewhere else that's not happening so of course we want to spend the money on health care of course we want to spend the money to improve outcomes the only thing that is stopping that progress on that is the federal government's willingness to just sit down and talk to us that's all we're asking for I mean it's really not a it's really not meant to be a controversial ask just come and talk to us there's lots of stuff we can do together we want to do that you know I think over the last couple of years the challenges everyone's gone through worldwide across Canada and as Canadians we all pitched in we all worked hand in hand with each other you know the the province has all helped out you know Dr. Fury sent his lovely wife Allison over to Ontario to help us out in a desperate need but every everyone pitched in and you keep hearing the word collaboration and cooperation that that's all we're asking for you know we we all have a great relationship I'll speak for myself I have a phenomenal relationship with the deputy prime minister I think the world of christia I have a phenomenal relationship with minister LeBlanc you know as as the the premiers hurt hurt me say I think he's he's great I must have said it three or four times and in our meetings over the last few days but that's what's bothersome you know we we need to sit down Canadians expect it they expect us to work together as I said earlier on they don't care where the money is coming from but the burnt-out nurse that's working around the clock you know 24-hour shifts um you know they need they need the help from the province and the feds when the doctors are being burnt out they need the help when we're hiring more nurses in Ontario hired over 10 000 healthcare workers since the pandemic we created 3100 more beds we put 40 billion dollars into infrastructure into new hospitals hospitals and and expansions right across this province but it's not sustainable even as the largest province we cannot continue at the pace we're going without the support of the federal government and you're hearing the same tone from everyone just come to the table it's not uh you know you against us it's all the same taxpayer there's going to be accountability at all levels and uh we just need your help so we're asking come to the table and what we'll work with you and that's the only way you get things done not going through the the media and I say that respectfully to the media because you're doing the job you have to do uh come to the table John I just uh I just add to that as to the uh something Andrew had said a few minutes ago around the missed opportunity that we uh that we are or that Canadians are missing by essentially the federal government not coming to the table having the conversation with the 13 individuals at that you see in front of you here today and I would use an example as we found our way through the the last couple of years and through our our Canadian experience of what was a global pandemic we met weekly us 13 the 13 premiers or maybe it was a little different variation of us during that period of time but we met weekly for much of that time and we met either weekly or bi-weekly as well with the the prime minister and the deputy prime minister often was on those calls as well and we had put together you know a partnership funding agreement a partnership support agreement being the the safe restart agreement it went far beyond healthcare what was what was but was based in supporting Canadians through what was a very challenging time we saw the federal government procure vaccines we saw the the provincial and territorial health systems actually deliver those vaccines to Canadians we saw the Canadian government procuring PPE equipment we saw the provincial entities actually then dispersing that that equipment to Canadians we saw testing facilities pop up across provincially and territorially operated testing facilities pop up across this nation yes there was some financial support from the federal government so that we could provide the services that Canadians needed over what was a very very challenging time for for all of us on on earth I would say but in addition to that we saw additional federal funding that was provided and then added to by the provinces for schools for example in Saskatchewan or we had 75 million dollars I believe came from the federal government we added another 80 million to that and provided that to our school divisions in the province to ensure that they had the funds to keep our children as safe as possible through this very challenging time the municipalities that were you know running their their transportation systems that may be 25 or 30 percent of the of the the rate that they normally would the federal government yes did provide some dollars in our case about 70 million dollars that we flowed through the municipalities and we added 150 million dollars to that to keep our municipalities as funded as possible through what was a very challenging time from their from their desk as well I would say that that relationship and that agreement and that discussion that we had over 20 or 25 meetings I suspect 36 meetings I'm correct I stand corrected by the current chair is really an example for us to come together once again and to actually have a a very fulsome conversation not only about how we're going to support Canadians from a healthcare perspective in into the decades ahead and and quite frankly the provinces aren't going to be able to do that when they're funding 78 percent and likely that percentage increasing in the years ahead but we're going to miss out on the opportunity that that Andrew had alluded to with respect to how we are going to shift and change this healthcare system that needs to look quite different in the future the last significant increase we had in the in the Canada health transfer was some 30 years ago you think about the healthcare system we have today and what we're asking it to address and how we're asking it to service Canadians today versus 30 years ago and you think about what we need to do in the decades ahead and most certainly this is an opportunity and I think Canadians should be disappointed that this is an opportunity that as as it stands today the federal government is missing out on participating in I'm just going to add a bit here too if that's okay John you know I've been here six years now the longest standing current Premier and I've never seen this table so sophisticated in in all of my time the conversations that have brought us together during the pandemic the conversation about mental wellness and substance abuse that all of us did with the promising practices podcast the conversations that we've had with every just jurisdiction what work we're trying to do to modernize healthcare in our in our in our communities and I tell you when we're in the in the pandemic when we told Canadians hope is on the way there's light at the end of the tunnel vaccines are coming you know there's there's going to be better times ahead it's that hope that really did help a lot of people to say we're going to dig down a little bit more and we're going to we're going to bear down and what we're seeing right now is nurses and doctors in ERs that are are afraid that they're going to hurt themselves or their patients and they're looking for us to find solutions and to come together and to share all this information together and we've been told to begin with wait till COVID is you know no longer such a big issue wait in between the two elections of the big provinces we've been told a few different times what to wait for we need a date we need to know exactly when we can get to that table the nurses are ready we met with them this week and they talked about how they would love to be at that table as well Dr Catherine Smartt the president of the Canadian Medical Association from Whitehorse met with us as well they're ready to come down and talk about best practices they're ready to talk about what we could do to modernize this system we need the federal government to tell us when we're going to have this conversation and give some hope to people that are on their last strings right now thank you last question today Camille Baines Canadian press hi i'd like to know if there were any discussions on how limited resources even if it's 35 from the fed could be stretched to benefit multiple jurisdictions so if you have a specialist who treats a rare disease could that person not be doing virtual appointments in different provinces well that that's a very good question and that's the type of innovation that is happening now amongst the deliverers of the service and we can enhance that by having again a national discussion and dialogue with the federal government about how we further advance those types of initiatives we we don't need to recreate wheels the the romano commission some how many years ago was that a long time ago laid the foundations of what the expectations were then we don't need to go back to that what we need to do is find better ways to deliver the services that people expect and with innovation in the sector whether it be pharmaceuticals therapy and other therapeutics whether it be new technologies whether it be diagnostic or otherwise it's how do we collaborate across the country as we did through the pandemic how do we do that going forward and to do that we believe we need to have a partner an equal partner in the federal government which has been the foundation of the delivering health care in Canada since the 1960s and again it is it separates us from our our cousins to the south we are the envy of north america because of what we have i talked to governor j inslee my colleague to the south of us in washington state and he would he would love to have a system where anyone who needs health care can get health care without checking with their banker first these are things that we take for granted in canada but we need to we need to remind ourselves how precious this is and we need to put care and attention towards making sure it will be here for us a decade from now and two decades from now i don't know if anyone else wants to yeah just at the risk of sounding really repetitive now is the time during this time of disruption i used to see for example patients from across newfoundland and labrador travel eight hours for a two-minute appointment i think that the pandemic has shown that you know you could probably do that that visit virtually but that that requires what you're describing requires an investment in technology and investment in broadband it involves in a structural change in how we license physicians and nurses across the across the country and it but more importantly it really unlocks the value across this table it locks the on the collaborative value here but it also locks the unlocks the value of medical professionals and i practice around the world that is the strongest here in canada and i think despite some of the the conversations here today there is a significant amount of hope and optimism for a modern system that is sustainable and one that addresses the permanent needs of canadians long term but this is a generational opportunity right now we all recognize it and i hope the federal government does do okay if we can everybody just get face forward we'll take one quick picture wonderful that's all the time we have thanks for joining us today and just be just before you all go for those of you've come from away to victoria i want to thank you for coming and if the federal government needs any encouragement i'll just say that uh we in british columbia know that the weather is a federal responsibility so i want to thank the prime minister for the past few days it's been outstanding and best of luck to you all saloo safe travels home