Good afternoon.

I'd like to thank Mark Adler for that warm introduction. And, I thank the Economic Club of Toronto for hosting today's luncheon.

I am truly pleased to have the opportunity to speak about my favourite topic - health care - in an economic context.

And, I say this, not just because at $28 billion dollars, health care is an important sector of the economy - employing hundreds of thousands of people and acting as a major purchaser of goods and services. Health care also brings an important economic advantage to Canadian employers, saving them billions more in insurance premiums, while enhancing our province's productivity.

But, even more importantly, medicare - our system of publicly funded health care -- is the best expression of Canadian values. It is these values that fuel our determination to improve health care and put it on a sustainable path for the benefit of future generations of Ontarians.
Like you, Premier Dalton McGuinty and his government believe in medicare. We believe in it so strongly, in fact, that one of the first bills we introduced was the Commitment to the Future of Medicare Act. This Act provides enduring protection for publicly-funded, universal health care in this province.

There are obvious pressures on our health care system -- an aging and growing population, demand for access to new technology, and emerging public health threats from an increasingly, connected, world. While some of these costs can be managed, costs that rise beyond the rates of economic growth over the long term are clearly unsustainable.

The challenges are enormous, of this I have no doubt. The pressure to produce meaningful results can be daunting. But it's also tremendously exciting and fantastically rewarding. And, because we're talking about health care, I know that we have the full support of 12 million Ontarians.

Today, ladies and gentlemen, I'd like to share with you some of the reasons that I'm so excited to have this job at such a crucial juncture in the life of our health care system. This is a remarkable time for Ontario, and for health care.

Over the last few years our health system has faced significant challenges and it has undergone tremendous scrutiny. Review after review, study after study, have only served to reinforce the notion that universal, single-payer publicly-funded health care continues to be the right way forward. But, they also concluded that within that framework, major reform is required.

None have spoken on that subject as loudly and as clearly as Roy Romanow. And, as we embark down a path of change, I feel a sense of good fortune that his thoughtful report provides us with a clear road map to guide us.

I know that there are many people in this room who agree with me. They believe that medicare is worth preserving, that it can be preserved. When I look around I see a fine selection of the people who I have been so gratified to meet in the short time since my appointment as health minister. They give so much of themselves, each and every day, in the name of our health care - on behalf of you, and me, and our families.

I call these people my health care heroes, and a few of them I'd like to single out for you today.

Louise Binder, is a passionate voice from voices of positive women. She is someone I've known for a long time.

Carol Miller, from Stratford, is someone that I have met more recently. She is a breast cancer survivor who has shown leadership in helping to raise hundreds of thousands of dollars. But way more importantly, she has given people an emotional outlet through a quilt project as a remembrance of people who have fought breast cancer.

Dr. Phil Berger is a man with an extraordinary strong reputation for making hospitals connect and be relevant to really diverse communities.

Dr. Alan Hudson has provided exemplary leadership across such an amazing diversity of roles in our health care system.

And my newest health care hero is Kristopher Knowles. Kristopher Knowles came today from Kingston, but makes his home in Sarnia. Kristopher's 13, and Kristopher needs a liver. He's had 20 operations and right now he's embarked on an Ontario-wide, and hopefully a Canadian-wide tour, designed to enhance the understanding and to promote the idea that there is something all of us can do. There is one thing that all of us can do, those of us who want to contribute to the sustainability of medicare built on our best values, and that's to sign a donor card. To make the ultimate sacrifice, and to make the gift of life to others. Kristopher Knowles is my health care hero.

I've invited a number of special guests today that reflect the diversity of our system. Sitting around the tables in front of me are representatives from community groups, health providers, consumers and government. There are health policy leaders and researchers, and of course some my health care heroes are here, too - the agents of change and beacons of hope in our system. They have infused in me a real sense of hope and optimism for the future. They have shown me that there are real opportunities for positive change all around us : Our opportunities to seize.

I declare the time for talking about reform over! People voted for real, positive change. Now is the time to deliver.

It's strange, but when my appointment as minister of health was first announced, the first thing most people would ask was, "are you scared?"

This was a question rooted in the belief that the challenges we face in health care are enormous and that they are too big for any one person to resolve. And it's true. There are enormous challenges and they are too big for just one person to fix. But, there are ways to confront these challenges head-on, solutions that require not just the labour of one, but the determined effort of all of us. Public health care deserves no less.

Everyone in this room today knows all too well that the challenges are great and the signs of strain are undeniable. But, many of us also know that we have a very good foundation on which to build and that the task at hand is full of opportunity.

The McGuinty government has already taken some substantial steps to seize those opportunities.

We have quickly moved to redefine our relationship with the federal government on the basis of cooperation, and we played a key role in ensuring the establishment of the National Health Council.

We appointed Dr. Sheela Basrur as Ontario's Chief Medical Officer of Health and now all Ontarians will benefit from her remarkable abilities as she leads the renewal of public health in our province.

When a Toronto hospital discovered a problem with the sterilization of medical equipment, I directed all hospitals to conduct an audit of infection control practices. A process that brought cultural change to hospitals.

We've taken decisive actions to protect our seniors in long-term care facilities by conducting unannounced annual inspections. And my Parliamentary Assistant, Monique Smith is conducting a top-to-bottom review of long-term care to make the system more transparent and responsive to the needs of our seniors.

Premier McGuinty and I are committed to restoring the foundations of nursing - foundations that have been chipped away over time. Because we believe nurses are at the heart of the health care system. We targeted some of the federal Diagnostic and Medical Equipment funding to purchase safety equipment in our hospitals, such as ceiling-mounted bed lifts. This is the first of a long-term strategy to invest in better working conditions for nurses. And we've challenged hospitals to convert overtime dollars into full time stability for Ontario nurses.

Last but not least, we introduced two cornerstone bills that set the stage for transforming the system.

Bill 31, the Health Information Protection Act received first reading and has gone through extensive hearings through the committee process. Bill 31 would - for the first time ever in Ontario - provide broad legislative protections for the privacy, confidentiality and security of personal health information. And it helps ensure that the information is used judiciously to improve health care and facilitate system change.

Bill 8, the Commitment to the Future of Medicare preserves in law the right of all Ontarians to access essential health care services based on need, not ability to pay. It introduces tough prohibitions against "two-tier" medicine, requires mandatory reporting of practices like queue-jumping and extra billing and offers whistleblower protection so that these activities can be stopped. Furthermore, it will usher in a new era of accountability in health care.

As we move forward with improving our health system, the Commitment to the Future of Medicare Act represents an important signal to Ontarians that the significant changes to come, rest on a strong foundation of familiar values. While others might suggest that the only way forward is to abandon these principles and to throw up our hands in surrender, we will prove that health reform can - and must - be consistent with these values.

The Romanow Report has set out, in clear and compelling terms, what our health care system needs. It's time to take the necessary steps to get us there!!

So, what will a revitalized health system look like?

Well, frankly, it will look a lot more like a system! Services will be better integrated amongst the various providers that deliver them and will be modeled with the consumers' interests in mind first and foremost.

I often say that when I look at the health care system, I don't really see a system at all. It's fair to say that many Ontarians don't experience a health care system either.

Our vision is to build a true system - one that's integrated and driven by one common cause - to deliver the highest quality outcomes for people.

Our vision is of a system where all providers speak to one another in the same language, where there are no longer impenetrable and artificial walls between stakeholders and services: a system driven by the needs of patients, not providers.

Accountability is the watchword of our renewed health care system. Let me be clear, by accountability our government means that we share a responsibility with providers to deliver quality outcomes to our most important stakeholder - the 12 million Ontarians who are counting on us!

To deliver results we need to set priorities. We believe that if you have 100 priorities, you really have none. Our government has three key priorities that we will be measured against :

• Reducing wait times for important procedures, for example cardiac care, cancer care, and hip and knee replacements.
• Improving access to family physicians and other members of the primary health care team, and
• Making Ontarians healthier - a priority that will be measured by the rates of physical activity, smoking and obesity

To achieve these priorities, some very fundamental changes will be necessary.

There are four change strategies that we will initiate over the next year that I'd like to highlight to you today :

• - Placing hospitals on a sustainable financial footing
• - Creating a culture of accountability and improved outcomes
• - Creating strong community health care services, and
• - A new emphasis on healthy living, prevention and health promotion

In each of these areas, fundamental change is necessary. I see these reforms as complementary, and I see them as absolutely crucial.

Let me start with change in our hospitals.

Over the last few years, hospital funding has been growing at alarming rates in the range of 10% per year. And while part of this can be explained by a growing and aging population, these kinds of increases are simply not sustainable over the long term. Furthermore, because hospital funding is the single greatest line item in the provincial budget, our inability to reign this in poses a threat to our health reform objectives.

I don't know if there's a simpler way or a nicer way to say this, but it can't go on. It just isn't sustainable.

I'm not saying that hospital budgets cannot grow. They can and they will. But they cannot grow the way they've grown in the past.

Let me be absolutely clear: the days of double digit increases in hospital funding are over.

Hospitals are like the anchors on the health care tug of war team. In the coming days our hospitals will be called upon to take up a dynamic challenge. To improve performance within an environment of stable yet restrained growth.

I recognize the challenges that this will pose to a hospital sector that has become accustomed to getting huge budget increases each and every year. But, hospitals will not be asked to face the challenge alone. They will be assisted by our transformation agenda that, at its core will reduce growing demand on the services that they provide.

Hospital funding must be more stable and predictable, and spending needs to be aimed at achieving results. Let me tell you what I mean by that.

For too many years now, government and hospitals have allowed a culture to develop in which many of our province's hospitals continually run annual deficits. And at the end of the fiscal year, the Ministry of Health faithfully bails them out. What's more, hospitals have been allowed to accumulate large working fund deficits, made up in part by unpaid operating bills from previous years. Servicing that debt is costing hospitals millions and millions of dollars. Money that is being diverted from providing services to patients.

There are a lot of reasons why that happens, but I think we can all agree that it's not healthy and that the status quo is unsustainable.

What's needed is a transformation to a new framework of accountability and sustainability. Not another short-term fix, but a true ’transformation.’

Let me tell you how this transformation will begin.
I am announcing today that my Ministry will provide Ontario hospitals with the $385 million needed to cover the operating shortfall from the fiscal year 2003-04. With this funding, we will introduce a new approach of linking funding to achieving desired results.

One of the starkest signs to me that we need to improve the way hospitals use their precious resources is nursing. Let me describe to you the state of nursing in Ontario today :

• Only 57% of nurses have full time job opportunities.
• Meanwhile, there were 2.7 million hours of overtime worked by nurses in Ontario hospitals.
• Hospitals purchase 2 million hours of "triple-time" agency nurses.
• Among health care workers, nurses are at the greatest risk of workplace illness or injury. For example, in 2002 nurses filed 1,481 WSIB claims, totaling 52,105 lost days of work.
• Nurses are the heart of the health care system. But this precious resource is being squandered. That's got to end.

That is why I am announcing that $50 million of the $385 million will be targeted exclusively to create full-time nursing positions and improve the safety and working conditions for nurses. If hospitals fail to reach targets for creating full time nursing positions, they will lose the funding and it will be invested in other hospitals that can achieve desired results.

We didn't authorize or approve hospital deficits, but we will pay them. The alternative would result in the shortfall being made up on the backs of patients and communities. And that simply is not an option.

But this will be the last time this government will do this.

From here on in, we're embarking on a new era of fiscal realism. If working people of Ontario can live within their means, it's time the health care system did the same. And that comment is not directed only at hospitals, but at the entire sector including my own Ministry. It's a new era of fiscal realism for all of us.

I would also like to acknowledge that our government recognizes that hospitals are also sitting on $721 million in cash pressures, accumulated over the past few years. Quite frankly, I am amazed that this had been allowed to go on for as long as it has.

How did we get into this mess? Frankly, there has been a lack of accountability from hospitals -- and a lack of leadership from Queen's Park. I'm here today to tell you : those days are over.

We are willing to talk to hospitals about the prospect of providing some relief. But understand, if any money is going to flow, there will be strings attached. None of this money - or any other in the future -- will flow to any hospital unless it commits and adheres to clear accountability requirements.

The accountability requirements are about a new relationship with our hospitals - a relationship that for the first time ties funding to results, rewards good performance and has real consequences for poor performance.

Here's how it would work.

The Ontario government, the insurer, would enter into agreements with each institution to ensure targets are set for service delivery and volumes, as well as achieving key government priorities - like a higher proportion of full-time nursing -- in exchange for funding. Like many of you would expect to see in your own businesses, it would ensure a clearer recognition of the contractual nature between payer and provider. It would also ensure that there are penalties for those who fail to deliver on their commitments.

It's funny how in some circles this seems like a radical concept. What's radical, I would suggest, is that in Ontario it has never been done before.

Government must also change its behaviour towards hospitals. In the past, the absence of stable, predictable funding has made it more difficult for hospitals to plan effectively, which often contributed to the deficit trap.

Having clear rules for how hospitals are funded is an essential part of ensuring that they are given the resources to actually deliver on the requirements set out in their agreements.

To that end, hospitals have been working with government through the Joint Provincial Planning Committee on a new, more predictable method of funding hospitals that enables longer-term planning and links funding to quality results.

Make no mistake, accountability and predictable funding must go hand in hand.

We believe that transformation must begin with making hospitals - the largest component of our health care system - sustainable and accountable for delivering results.

In fairness to hospitals, I recognize that many of them have been put in an untenable position. They've been forced to pick up the pieces when other parts of the health care safety net weren't able to deliver effectively. This has resulted in cost pressures while hospitals expanded services to meet growing demand.

Our plan to introduce accountability agreements is not to pick on or punish hospitals. Instead, it is to bring new clarity to the relationship in order to secure mutual benefits to both hospitals and the public.

For too long now, we've been treating symptoms, not causes. A bit like cranking up your furnace in the middle of February, when what you really need is to close some windows! It's time to step back and get our house in order.

Therefore, this commitment to predictable funding will be accompanied by an equally firm commitment to investment in the complementary community-based services needed to allow hospitals to do what they do best. Hospitals are expensive places to treat patients. Yet, far too many hospital days are taken up by patients who don't need to be there at all. Institutional long-term care and home care supports are two examples of alternatives that can facilitate safe and appropriate early discharge from hospital. Furthermore, community and home supports can help keep people out of institutions in the first place.

The evidence is overwhelming that these can be cost-effective alternate approaches, so why are we not taking better advantage of these options?

By taking steps to put these community and home supports in place, we can reduce the unfair and unnecessary burdens placed on our hospitals, allowing them to plan their budgets, and serve their patients, more effectively. Furthermore, by doing this we can act in the better interests of patients' health and comfort.

The second change strategy focuses on making our health care system more accountable, more focused on outcomes, and more committed to quality care.

Often it's been difficult to develop and execute accurate methods to measure our system's outcomes. Things like ’quality’ were difficult to judge and to quantify. And even things like wait times were impossible to measure with any real accuracy.

We need clearer performance targets, greater transparency, and better lines of communication. It's time to actually transform our health care system into a ”system” focussed on results.

Results-Based Planning focuses on achieving results in priority areas, rather than the scatter gun approach of the past. It makes sure that the money we spend achieves measurable and meaningful results that people care about. It gives Ontarians some clear and easy measures to check government's progress and hold us accountable, too.

Bill 8 plays an important role in our results-based planning agenda by creating the Ontario Health Quality Council, an independent, arms-length body responsible for reporting on important health quality indicators to assist us in raising the quality of our health care system.

The Council would measure the effectiveness of the system and report on its performance in priority areas that Ontarians tell us that they care about most.

Finally, we're working on a new strategy to create incentives and rewards in the system, allowing us to target resources towards particular challenges. I've talked about how Ontario's hospitals will be required to meet performance goals including targets for better managing clinical and human resources, namely creating full-time nursing positions. And results-based budgeting will be extended to the entire public health care system.

All health care providers will be made accountable for how well they work together to meet the needs of patients. Information technology will be a major enabler because it allows health providers to talk to each other and share information. It will also revolutionize our ability to evaluate system performance. That's why we will put health information technology integration in forward gear.

The third area of reform is what I call 'The Transition to Community.'

If there's one basic solution to making care more effective and more sustainable, it's this : putting it into the community.

I haven't been the Minister of Health for very long, but one thing I know is that Queen's Park certainly does not have all the answers. I'm a great believer in government, and I can tell you that the people in my Ministry are some of the brightest and most committed public servants I've ever encountered.

But trying to run Ontario's health care system from a suite of offices at Queen's Park is like trying to shave while blindfolded. You're not quite sure what you're doing, and the risk of slipping up is enormous.

What's needed is better integration and planning at the local level so that we can deliver better results in each part of the province. Not a regionalization model. A made-in-Ontario solution that builds on the strength of our community-based organizations large and small.

As Romanow showed us, primary care renewal is the foundation on which the transformation of our health system must rest. At its heart, it promises to improve access to primary health care services and prevention and serve as the golden thread that will help weave the disparate parts of our health system together.

Our government will move decisively on primary care renewal by acting on our commitment to create family health teams that will provide comprehensive family health services, around the clock. This approach will allow physicians to work as part of a team with other health providers, rather than in the isolation of sole practice. Physicians, nurse practitioners and other members of the team will benefit by working together in a positive working environment, sharing and benefiting from the complementary knowledge and skills of their colleagues.

Patients will benefit, too, by having improved access to a range of family health providers that will care for them when they are ill and help them stay healthy in the first place.

The federal Health Accord allocates money to expanding primary care reform and we will take advantage of it!

Effective home care services are also very much a part of our plan for putting care in the community.

Romanow calls home care the next essential service. And we agree.

Nowadays services that used to only be provided in institutions can be delivered at home. Home care can offer greater dignity and quality of life. Many prefer the independence of receiving care in their home, but too often this is not an option. And we know that home care is often less costly.

We are too reliant on institutional care. We are going to change that.

Accord Funding
If what I say about investments in the community, in primary care and home care, has a familiar ring to you, this should not come as a surprise. It's been spoken of constantly. But, we aren't interested in just talking.

As a first step to put care in the community, we will invest the Federal Health Accord dollars this year in home care services, catastrophic drug coverage and the development of family health teams. This will help us build our capacity to care for people in their communities, and integrate community services with institutional care.

Finally, let me speak a little bit about the fourth positive change strategy : a more expansive focus on healthy living and prevention. Our goal is to help Ontarians be the healthiest people in Canada. This is a target we can meet. And, I'm pleased that my Parliamentary Assistant, former Olympian Peter Fonseca, has signed on to help show us the way.

But 'good health' means more than being free from illness. It means more than having a bone set properly when it's broken, or a wound treated promptly. Good health encompasses a broad range of factors, including nutrition, environment, exercise, disease prevention, health promotion, and health protection.

We've developed a good model for treating illness. But we don't have an effective strategy for keeping people well.

And we intend to move aggressively to give all Ontarians the resources and support they need to achieve good health. It doesn't matter whether you're a senior citizen, a farmer, or a logger. Our goal is to improve your health.

To make Ontarians the healthiest Canadians we will tackle the most high cost, high burden and preventable health issues - these include smoking, childhood obesity, onset by inactivity and disease.

Our government will undertake an aggressive plan to reduce tobacco use, to protect people from the harm of second-hand smoke, helping those already addicted to quit, and preventing our youth from taking up this deadly habit.

On that point, I am often amazed when I pass by a high school and see teens huddled out front over their cigarettes. Given that selling or giving tobacco to minors is illegal, you've got to ask yourself how this could be - who are their dealers? And, what are we as a society doing to stop this?
The social and economic costs of obesity are also enormous. Obesity often starts in childhood and many of the causes and cures are well known. Our government will attack the root causes of obesity on two fronts : by increasing physical activity and promoting healthier food choices.

Another area we must tackle is domestic assault, not only because it is a reprehensible social problem, but because it consumes a remarkable amount of our health resources.

As we go about our daily lives, all of us can take real action to help ensure the sustainability of our health system. Just as with energy conservation, choices you make today can help ensure health care will be there tomorrow. By choosing to take the stairs or walk around the block, or preventing a teenager from taking up smoking, you can make a contribution towards a more cost-effective health care system.

It's logical to question how modest sacrifices made by just one of us can possibly make a difference to the survival of publicly-funded health care, but multiply those benefits by 12 million of us pulling in the same direction and they are significant indeed!

Health care is a $28 billion dollar pie, stretched out across an unimaginable number of boundaries. Boundaries between hospitals, regulated health professionals, labour, and management, communities, and even religious orders.

Let me also come back to an issue I touched on earlier : money. I acknowledge the inherent tensions in the heath care system around money. I knew they existed before I started this job, and I sure know it today!

These tensions will always be there. But we can take huge strides towards better health care beyond just spending more money. I don't believe every issue can be reduced to a 'showdown' about dollars and cents. There are a lot of other resources, a lot of collateral 'good' in our system' which can be leveraged. That's the medicare advantage.

The task at hand is a tough one and it will challenge the status quo. Some familiar and established structures will be transformed or may even disappear altogether, while new ones will emerge. There are many entrenched interests who may be resistant to change and may argue against the needed reform.

But, we must recognize that we are in this together. And, in the end, we will all share in the benefits.

I believe our government has provided some real leadership on these issues. And in the coming months, I'm determined to work with you to move forward with the transformative changes I've outlined today.

In closing, I would like to leave you with one final thought - a challenge, actually. A challenge to all of you to be part of the solution.

A truly effective, patient-focussed health care system is within our reach. In fact, many of the components are already in place. What we need now isn't simply more money, but a more determined effort to make the various parts of this system work in harmony. It's time to say goodbye to the silos.

It's also time for a cultural change. Time for a new atmosphere of trust, accountability and co-operation. An end to the bickering and the turf wars, and the beginning of a new, collaborative effort to make this system fire on all cylinders.

It is also a job for all of us. Every single Ontarian has a stake in the outcome. Every single one of us has a contribution to make in the transformation of our health system. I say it's time for Ontario to lead the way again.

Let's get it done together!

Thank you.