Good morning.

It is a pleasure to be here at St. Michael's today, and to be speaking to you from my home riding of Toronto Centre-Rosedale.

I'd like to thank Jeff (Lozon) for allowing us to gather here to make this important announcement.

And I'd like to extend my thanks also to Tony Dagnone, Chair of the OHA Board, for his support for today's announcement.

I'd also like to acknowledge and thank the following people :

• Ken Deane [Chair, JPPC Funding Formula Committee, and President and CEO of Hotel Dieu Grace Hospital in Windsor] and Frank Markel [Executive Director of the JPPC], representing the Joint Policy and Planning Committee.
• Mary-Catherine Lindberg of the Ontario Council of Teaching Hospitals
• Doris Grinspun of the Registered Nurses Association of Ontario
• Janet Napper of the Hospice Association of Ontario
• Jim Armstrong of the Ontario Association of CCACs
• Susan Key of the Association of Local Public Health Associations
• Barbara Everett of the Canadian Mental Health Association
• Dr. Danielle Martin of the Professional Association of Interns and Residents of Ontario
• Dr. Dev Chopra of the Centre for Addictions and Mental Health
• And representatives from the Ontario Association of Non-Profit Homes and Services for Seniors, and Ontario Long-Term Care Association and Ontario Nurses Association (TBD)

It's a pleasure to be in the company of the professional staff who are on the frontlines doing the real work of delivering care. Thanks for all that you do.

The people of Ontario can be proud that they have one of the best hospital systems anywhere in the world.

For more than a century St. Mike's has represented many of the things that are so great about our province's public health care system.

As a recent recipient of the Registered Nurses Association of Ontario's Employer of the Year Award, St. Michael's has demonstrated a commitment to supplying nurses with the resources and education they need to deliver the highest quality of care to patients. And as the site of Canada's first infirmary for the homeless, St. Michael's has demonstrated a commitment to care that goes deep into its community.

Hospitals are the anchor of Ontario's health care system. In communities across the province, hospitals stand out as the most visible symbol of health care.

But, let's be honest, for too long hospitals in this province have been asked to do much more than they are built to do. Our government's strategy is clear. We are working to free our hospitals to provide the kind of care that only they can provide - acute and surgical care.

First and foremost, our strategy invests new money in a way that views health care as a system, not a loose collection of silos.

If you measure what we have against the word "system" in the dictionary, it's pretty apparent that for all of the use of the word we don't have a health system here in Ontario. We have really good hospitals, some of the finest nurses and doctors anywhere, long-term care homes and home care services in virtually every community, but all too often we think of these services as separate and unrelated.

We're taking aggressive steps to change that. To shape health care delivery from the patient's perspective. Recognizing that when it comes to the delivery of health care, the hospital and the public health nurse are linked - that we're all in it together. And we're all in it for our patients.

Our government has a clear plan to transform health care by investing in effective community-based health services located close to people's homes.

And we're putting precious resources in place to back up our vision.

Home care, front-line primary health care, community mental health, strong public health and prevention all result in a healthier population and contribute to the sustainability of our cherished medicare system.

And driving care down into communities relieves the pressure on hospitals that have been asked to shoulder too much of the weight of health care for too long now.

Strong complementary community health care will free up the staffs and resources of hospitals to focus on serving people with the most acute health needs.

We are investing in five key areas of community care. Here's what we are putting into communities this year alone :

1. $103 million for home care, plus another $29.2 million for community support services
2. $65 million in community mental health services
3. $406 million in new funding for long-term care homes, which will grow to $531 million annually
4. $111 million to enhance front-line primary care and create Family Health Teams
5. $47.5 million more to increase the provincial share of public health costs, plus $41.7 million to launch an action plan to restore public health

The long-term commitments we are beginning this year will enable thousands and thousands more Ontarians to receive care in their communities and their living rooms rather than queuing up in emergency waiting rooms.

An equally critical part of our plan for change is placing our hospitals on a sustainable financial footing.

I'm going to share with you today our government's plan to assist hospitals to deliver quality services this year, and to strengthen their financial wellbeing into the future.

I am pleased to announce that our government is injecting an additional $469.5 million dollars in Ontario hospitals this year, a 4.3 per cent increase over last year. Every Ontario hospital will receive more funding. This new money brings our total investment to $11.3 billion dollars - the largest single expenditure item for the Government of Ontario.

This year, nearly 50 per cent of new hospital funding will be provided using a new, more equitable and transparent funding model developed by hospitals and the government through the Joint Policy and Planning Committee - a partnership between the Ontario Hospital Association and the Ministry. Ontario hospitals have been involved in a painstaking process since 1992 to develop a funding model that responds to different community health needs and rewards good practices.

In the past, all hospitals received the same across the board increases - no matter how well they performed. This new formula compensates hospitals fairly by taking into account their relative efficiency, the needs of the populations they serve, and the type of services they provide. Most importantly, it rewards good performance. Because we believe that rewards encourage excellence and are crucial contributors to an era of accountability,.

This nearly half-a-billion dollar investment will allow hospitals to reduce wait times in key areas including cardiac care, cancer care, hip & knee joint replacements, cataract surgeries and dialysis treatment.

And these new funds will allow hospitals to continue creating more full-time positions for nurses.

Because nurses are the heart and soul of the health care system.

There is no greater priority for our government than rebuilding the foundations of nursing. The commitment we've made to nursing is for the long-term. We are investing in better and safer working conditions, and creating more full-time opportunities so that more nurses can and want to stay in the profession here in Ontario.

We are making measurable progress. Already this year we have targeted funds to create 2,400 full time nursing positions. This includes :

• $50 million earmarked to create 800 new full-time nursing positions in hospitals.
• $50 million for a strategy to hire 1,000 new full-time nursing graduates and create employment opportunities for senior and injured nurses in hospitals and long-term care homes
• $191 million for 2,000 new staff including 600 new full-time nursing positions in long-term care homes.

Hospitals large and small all across Ontario are revising their nursing policies and enhancing stable employment opportunities for their nurses.

Here at St. Mikes, they've stepped up to the plate with a plan to hire 70 full-time nurses and reduce overtime and the use of agency nurses. Since March of this year, St. Mikes has already hired 66 new full-time nurses. It has used the government's targeted monies to create 18 positions and brought an additional 48 new full-time nurses on board refocusing existing funding away from overtime to stability.

But we need to do much, much more to obtain full-time opportunities for at least 70 per cent of our nurses.

So, to help ensure accountability for targeted investments in nursing, all hospitals will be required to have local nursing union representatives sign-off that targeted nursing monies were used exclusively to create full-time positions.

Our government is looking to make hospitals, along with the entire public health system, more accountable to the people of Ontario. That includes our own government.

Over the next few weeks, hospitals will be asked to sign-back an agreement detailing the accountability requirements for their new funding this year. This agreement will require them to increase the percentage of nurses working full-time and to work towards a goal of having a minimum of 70 per cent full-time positions. And it will require them to protect priority programs and reduce wait times in areas including hip & knee replacements, cardiac surgery, cancer services, MRI services and cataract surgery.

This will be transitional agreement this year while the ministry works collaboratively with hospitals to establish the Accountability Agreements that are required under the Commitment to the Future of Medicare Act.

Last week, more than 100 hospital executives and Ministry staff held a simulation event to practice developing Accountability Agreements. This reflects a very high level of commitment on the part of hospitals and the government to be more accountable to patients.

Our government believes accountability is about collective responsibility - the responsibility of the government, and the responsibility of all providers and all health professionals. And it's about the responsibility each and every Ontarian has for their personal health choices.

Despite the half-a-billion dollar investment in hospitals this year, we know that some hospitals will experience significant financial challenges. New technologies, growing populations, and rising costs all place new demands on hospitals - demands that are felt in all parts of our health care system.

Over the past number of years hospitals have seen double digit funding increases, which has left little room to invest in other crucial health services like home care, primary care, long-term care, community mental health, and public health and prevention. At the same time many hospitals have been caught up in a cycle of annual deficits and government bailouts. We are bringing these practices to a close.

Hospitals will continue to grow, but in a more moderate and managed way.

And we will not leave our hospitals to face their considerable challenges alone.

Our government will work with hospitals to deal with their unique financial pressures on a case-by-case basis.

Today I'm also announcing that we are giving hospitals an important additional tool that they have been asking for: the ability to balance their budgets over two fiscal years instead of one.

We're moving past the show down at the OK Corral to a more mature and responsible way of doing things.

The Ministry will also work with hospitals on a three-step plan to resolve financial issues. First, we will ask them to provide a plan to balance their budgets by the end of 2005/2006.

If they still experience difficulties, we will set up special "turnaround teams" made up of ministry officials, hospital executives and outside experts who work together on a plan to address their specific challenges.

The third step is a peer review process whereby executives from well performing hospitals assist other hospitals. We'll make the strengths of the system available to the entire system.

We got this idea from the OHA and it's a reflection of a new spirit of cooperation to find solutions to health care challenges.

This year we are making progress on introducing predictable, multi-year funding for hospitals. This year's provincial budget outlined the four-year operating budget outlook for the hospital sector. And, the ministry and hospitals through the Joint Policy and Planning Committee are developing a multi-year funding plan for all individual hospitals for future years. This will provide hospitals with an ability to plan and manage their resources that they have never had before.

For the first time, hospitals will be able to look to the horizon rather than plan out of the rear view mirror.

I am optimistic that we will be able to put our hospitals on a sustainable track.

There are many opportunities to make hospitals more efficient, and to better manage precious human and technological resources.

I want to acknowledge the leadership role that OHA is playing. The OHA has created an efficiency task force to find ways that hospitals can better collaborate and coordinate their services through practices like joint purchasing.

The OHA's task force on supply chain reported that a more efficient supply chain could save Ontario hospitals a minimum of $120 million annually through purchasing discounts, reduced inventory and more efficient handling of goods.

We can't afford to forgo these savings. We must rely upon the medicare advantage!

Luckily we already have a multitude of success stories from across Ontario.

Ottawa Hospital, for example. Following the very challenging amalgamation of six different facilities, the orthopaedic surgeons got together and realized they were using eight different devices for hips and knees. They narrowed the list to two and saved $1.8 million in the purchase of artificial joints. That $1.8 million bought 200 more surgeries for the Ottawa community!

Consider the Huron Perth Healthcare Alliance. In June of last year, the hospitals in Stratford, St. Mary's, Seaforth and Clinton agreed to form the Huron Perth Healthcare Alliance. The purpose of this Alliance is to find ways to make patient services and administrative services more integrated and more efficient. And it's working.

And so, notwithstanding obvious challenges, I am optimistic because there is a growing realization that we need to get on with the job of building a health care system that is focussed on patients, committed to quality and realistic about available resources.

The current debate about more resources for health care does not excuse us - cannot excuse us from one clear reality : we are in a period of restraint.

For if we assume that new dollars will simply pay more for what we already have, we will fail to address the public expectations that health care can be better.

In the coming months and years this will require all of us who are privileged to be engaged in the delivery of a cherished public service to look beyond our short-term self-interest and to work together on making real systemic changes.

For there is much more power to be found in the will of the 250,000 Ontarians who deliver health care then in all of the promises of more dollars from any government.

Meaningful systemic change will take vision, courage and fortitude. It will take all parts of the system pulling together for once.

And for those of us who believe that medicare is the best expression of Canadian values, it is a mission where failure poses risks to the very fabric of our nation.

I'm grateful for the privilege of making this announcement today in the presence of the women and men on the front lines of health care.

Thank you.