The last time all of Canada’s premiers sat down around the same table, their attention was focused on getting Ottawa to pay more to fix the understaffed, hospitals, shuttered emergency rooms, surgical backlogs and health-worker shortages threatening the viability of their health systems.

When they sit down in Winnipeg for their annual summer gathering this week, the attention will turn more to how to use the new money Ottawa has now promised.

After two years of provincial pleading and sabre rattling for a new health care deal, Prime Minister Justin Trudeau finally put new money on the table at a first ministers‘ meeting in Ottawa in February. That $46 billion-deal fell far short of what provinces had asked for but they were left with little choice but to accept it.

Dr. Kathleen Ross, the president-elect of the Canadian Medical Association, said health must remain at the top of the agenda.

“We are really on the peak of our challenges at the moment,” Ross said in an interview.

“We have to change how we are managing and delivering health care in Canada.”

Health care is expected to dominate the first day of the three-day meeting. Economic issues and affordability are also on the agenda.

Trudeau’s new health deal includes an increase to the annual federal health transfers — which provinces use to help pay for their health care systems — as well as money for still to be negotiated one-on-one deals tailored to each province and territory to address their specific needs.

The money came with conditions: each province and territory has to create targets and timelines that will be used to show that the money is being used to improve access and care.

None of the provinces or territories have submitted their plans to far, and the bulk of the new money isn’t expected to flow until they do.

Provinces and territories are likely to compare notes before handing their plans over to the federal government, said Nunavut Health Minister John Main, but ultimately they will be unique to the challenges in each jurisdiction.

“Things are quite fragile right now in terms of our staffing,” Main said of his territory.

“With the pandemic, it really changed the foundation in terms of staffing, and we also saw worsening of some types of public health issues that we’re dealing with,” including mental health and tuberculosis.

Nunavut officially signed on to the deal on Thursday, as did the Northwest Territories and Yukon.

That leaves Quebec as the lone holdout to officially join the pact.

Setting targets is an unenviable task for provinces, Ross said, but there are common areas the CMA would like to see them focus on.

They recommend a goal of eliminating backlogs for priority procedures within three years and eliminating emergency room closures, among others. In many provinces emergency rooms, particularly in smaller communities, have been closed temporarily due to staffing shortages.

Provinces and territories have been critical of how much money Ottawa put on the table.

The prime minister’s deal will increase the federal share of health care costs from 22 per cent to 24 per cent next year, far short of the 35 per cent the provinces and territories were demanding.

“It’s the starting point,” Main said. “It’s positive to see increased transfers, but is it enough? In my opinion, no.”

Health Minister Jean-Yves Duclos has called the offer “quite generous on a number of different levels.”

Several provinces and territories are aiming to get their plan approved by the federal government by the end of the year, which means they may not receive much in the way of new funds until the new year.

In the meantime, the federal government distributed $2 billion among provinces and territories last week to tide them over.

“That was in reaction to the fact that, over the last few weeks in particular, we have seen emergency departments significantly impacted by the health human resources not being available, and backlogs in surgeries and diagnostics,” Duclos said at a press conference Thursday.

Main said no province is likely to turn down one-time funds, but what they really need is stable, long-term money so they can make long-term plans.

“We’re looking for predictable funding streams so that we can plan out where to direct resources and so that we have some surety in terms of building out programs or bringing on additional staffing capacity,” he said.

The premiers are expected to publicly discuss how they plan to deal with the health crisis at the conclusion of their meetings on Wednesday.