Thank you Sheila for that very kind introduction.

It seems hard to believe that it has been just over a year since I, in a sense, introduced myself to you at your last convention.

Calendars don't lie though. It has been a year, and ladies and gentlemen, allow me to say that it has been quite a year!

It has been a year of great success, and occasional disappointment…of extraordinary cooperation and inevitably, some conflict… of a lot of talking and yeah, maybe more than one of us even yelled a little…

So I'd like to ask… please… see if you can let me get through this speech without yelling at me.

I mean, after all… you were nice to Newt Gingrich…

Seriously… this has been a year in which we have begun a journey together that will end with a health care system transformed… one that will provide quality, sustainable care for generations to come.

I made a joke just now about yelling.

I wasn't trying to make light of anyone's concerns.

I made it to underscore a point that I made in my speech to you a year ago.

There is a lot that I know now that I didn't know then, but I said something last November that remains 100 percent true today…

And it might just be the single most important fact about health care in this province.

I said that every single person in Ontario wants me to do well. And they really do. Nowadays, people stop me in the street. Some will say "good job", others will say "don't back down". And a lot of smokers… well they just give me hell.

But they all have a vested interest in what I'm doing… in what our government is doing.

There are 12 million people who if you asked them would tell you that they want a health care system that works for them when and where they need it, and will do the same thing for their children and grandchildren.

That's the job we have taken on, and in that respect we are no different from any of you, because that's the job you've taken on as well.

You are, if I might quote from your website, "dedicated to the continued improvement of health services in Ontario, through leadership, advocacy, education, commitment and service."

Let me take this opportunity to congratulate you on carrying that dedication for 80 years. The people of Ontario are immeasurably better off for those 80 years of commitment and service.

I spoke just a few nights ago at the AIDS Africa gala that kicked off this convention. We were raising money for the Stephen Lewis Foundation, and their heroic battle against AIDS and HIV in Africa.

Obviously, this was not directly related to health care in this province, but the event spoke to a global commitment to health care – and the humanity at the heart of that commitment - on the part of the OHA that I am proud to share.

The point is, we are all in pursuit of a first class, sustainable health care system, and if we have occasional differences of opinion about how to get there, those are not nearly as important as the fact that we are by God going to get there.

Those who dwell on health care's frailties while ignoring what is done exceedingly well undervalue the contributions of those who deliver health care, and they serve to diminish our collective pride in the best brand of Medicare anywhere.

That may seem idealistic… but something else I said a year ago is that I am very idealistic about our health care system. I am an optimist.

And when I look back over the past year, I see a lot to justify that optimism.

I want to congratulate you on the theme of this year's convention. Advancing Leadership and Accountability.

It is confirmation for me that in a great many respects – in the respects that count the most - we are singing from exactly the same song book. We all know that we are not going to solve the problems we have in health care – we're not going to make the vision of health care we share a reality – without leadership and accountability.

Leadership and accountability are exactly what I need from you, and I dare say they are exactly what you need from me.

About two weeks after I spoke to you last year, we faced an early test of our ability to work together… government and the OHA… towards a common goal. We directed all hospitals in the province to do an audit of their infection control practices.

I can't imagine that it was an easy directive to take. It was a difficult, painstaking job at a busy time of year.

But you did it. You showed leadership and you took accountability for the way you were doing things. We worked together very well, and Ontarians properly have even more confidence in their hospitals as a result.

I think we have demonstrated repeatedly during the past year that we have the will, and the ability, to work together in the interest of patients.

The work that is being done to develop accountability agreements through the Joint Policy and Planning Committee is another perfect example.

This summer I attended a simulation event to practice developing the Agreements. More than 100 hospital executives and ministry staff pulling together, in a collegial, professional manner. It reflected a very high level of commitment on the part of hospitals and the government to be more accountable to patients.

I did a little research in preparation for this speech, and it turns out that I have spoken at OHA events at least 20 times in the past year.

I see Warren DiClemente more often than I see my own mother…

…and he's nowhere near as good a cook.

I and my staff have met with at least 38 hospitals at Queen's Park.

I have visited at least 40 hospitals across this province.

Frankly, if there's a person in Ontario who's been to more hospitals than I have in the past year, I sincerely hope for their sake they were doing it on business.

The point is, we are not strangers, you and I, and what I have learned during those meetings, in paying those visits, is that if the only requirement for getting the job done was desire, then we'd have been there long ago.

Of course, therein lies the rub.

Wishing does not make it so.

It was John F. Kennedy who said "Effort and courage are not enough without purpose and direction."

You need a plan. You need it to be good. And you need everyone to pull together to see it through.

Leadership and accountability.

Ontarians expect, and deserve, both… from our government, and from you.

We recognized early on that our hospitals needed more nurses, and they needed the means to give their nurses a better, safer work environment.

We invested $50 million to create new full time nursing positions in our hospitals. To date at least 638 positions have been filled.

We also invested $39 million for modern equipment like bedlifts, as well as education and professional development opportunities for nurses.

We moved to address the shortage of doctors in Ontario. In 2005-2006, there will be an additional 56 medical school positions available through the Northern Ontario Medical School. We have invested $26 million to more than triple to 200 the number of training and assessment positions for International Medical Graduates. As of last month, 165 IMGs had accepted positions in Ontario.

Now… I have talked many times about the need to transform health care. I'd like to take credit for being the first to do this, but I'm not… not by a long shot.

You could probably fill a library with all the reports written by all the experts on how to transform health care, and for the most part they all come down to the same basic thing :

You have to reform primary care. You have to increase the access people have to front line health care, and you have to improve the quality of that care. You have to drive health care into communities, because the best health care is found as close to home as possible.

By doing this, you relieve the strain on hospital personnel. You ease the strain on hospital budgets. And you free hospitals up to do what they alone do well… provide acute care to people who need it, when they need it.

So no, I'm not the first to say these things, but I have every intention of being the first health minister, in the first provincial government, to follow through and get it done.

And we've spent our first year doing just that.

• We invested an additional $191 million to hire 2,000 staff in our Long-Term Care homes, including 600 new nurses. This investment will also allow LTC homes to meet a consistently high standard of care.
• We have renewed the province's commitment to public health, investing an additional $190 million this year. Our three year action plan, Operation Health Protection, represents the first comprehensive change to the Public Health System since the 1980's. It includes an initiative to vaccinate more than two million children, free of charge, against pneumococcal disease, chicken pox and meningitis.
• We increased community mental health funding by $65 million… the first such increase in 12 long years…
• There's $103 million more for Home Care…
• An additional $21 million for Community Health Centres…
• $29 million in community support services…
• We are spending $600 million over the next four years to build 150 Family Health Teams in communities across the province. These are in many ways the centerpiece of our transformation strategy. They will provide multi-disciplinary front-line care, with a focus on health promotion and disease prevention.
• And finally, I'm pleased to be making another in a series of announcements about community-based care that will ease pressure on our hospitals by freeing up acute care beds… we are investing $29 million to support our Alternative Levels of Care Strategy. This is a plan to move people who no longer need acute care out of hospitals and into more appropriate surroundings, like Long-Term Care homes. There are two programs… a Supportive Care Program, for people who are still recuperating but no longer need hospital care, and an Interim LTC Beds Program, for people going into long term care from hospital for whom there are no permanent beds. I will be providing more details about our Alternative Levels of Care strategy in the weeks to come.

This is a record investment that we have made in community based care, because we know these investments will pay dividends…

…dividends in the form of better health promotion, improved illness prevention, healthier Ontarians, and more sustainable hospitals.

We also reached what I consider to be a landmark agreement – albeit tentative – with the Ontario Medical Association. This was a case of government and physicians working together to create a plan to transform health care… to the benefit of not just 12 million Ontarians, but generations to follow.

The deal contains many initiatives to support Ontario's hospitals... in fact there has never been an agreement with the OMA that so specifically targets hospitals.

I'm talking about investing in increased access to priority services such as hips and knees, cataracts, MRI and CT, further investments in emergency room and on-call services, better recognition of in-hospital mental health care needs and a wide range of other hospital-based services. The agreement will facilitate better linkages between physicians in hospitals and their community colleagues.

It will bring more doctors to communities that need them, and overall it will result in a net gain in the number of doctors in Ontario.

It will ease the strain on hospitals by investing in comprehensive community care, long term care and care in the home. It will ensure Ontarians who are elderly or who have chronic diseases are better served in their home or community.

All of these things will serve to further reduce pressure on hospitals, which is good for you…and very good for the patients that rely on you.

That's a good year in my book. There are other things that we have done relating to wait times that I will be getting to in a few moments.

But I am prepared to stand here and say that we have accomplished a lot in our first year, and I suspect that based on the list of accomplishments I have just rhymed off most of you would agree… it has been a year of action.

Which brings me to another accomplishment, one on which there may be slightly less than complete agreement… but an accomplishment all the same.

I am, of course, talking about funding.

If anybody is labouring under the impression that our struggle to achieve hospital sustainability, and the dispute we are having about it, is somehow driven by personality, let me put your mind at ease.

It is not.

It is driven by cold, hard fiscal realities… realities that have led to a determination on the part of this government that no one should underestimate.

Let me lay out a few of those realities… things that are simply not up for dispute.

Hospitals are the single largest government expenditure… $11.3 billion this year.

Hospital budgets have grown by almost 10 percent a year over the past five years… almost three times as fast as the province's economy.

Almost as soon as we arrived in power we invested $385 million dollars to eliminate hospital deficits for last year. That was a 3.5% increase over previous approvals.

Then we announced $469 million in new funding for this year… a 4.3 percent increase, for a total budget increase of 7.8% in our first 12 months in office.

On top of that, we acknowledged $721 million in working capital deficits… a little surprise that was left for us by the Tories, buried in your books so they could make their books look balanced.

We did these things while making the record investments in community-based care that I was just listing.

So let me be clear :

Any debate that is framed by the notion that we have somehow left hospitals hung out to dry is ludicrous.

We have not.

The Tories cut your funding…by $557 million over two years. That's hanging you out to dry.

The NDP cut your funding… by $267 million in just one year. That's hanging you out to dry.

We are giving hospitals more than any government before us, while making unprecedented investments in primary and community-based care that will further ease the strain on hospitals immediately and in the long run.

But this has not been easy. The transformation of the health system requires a significant up-front investment from government and, therefore, a greater contribution from Ontarians towards the cost of their health care.

We are asking a lot of our province's hospitals, as we are from all parts of the health system, to support important and necessary changes. But, keep in mind, we are asking a lot from our citizens, too.

In the last budget, the Minister of Finance introduced a new tax measure in the form of a Health Premium dedicated towards enhancing the quality of health services in Ontario. We understand, as you do, that paying more in taxes is something that none of us want to do. Nonetheless, we also know that Ontarians place a high value on ensuring a quality, publicly funded health care system. It's a high priority for us because it is a high priority for them.

The decision to ask the public to increase their financial support towards health care was not an easy one. But it was the right one if we are serious about protecting and enhancing quality health services today and for the future.

The Health Premium, and with the additional $825 million we are receiving as a result of September's agreement between Ottawa and the provincial and territorial governments, give us an historic opportunity to make the changes in health care that we know need to be made.

And that does not mean taking a pot of money and throwing it into health care in exactly the way it has been thrown in previous years, secure in the knowledge that next year, we'll need a much bigger pot.

Because we know the pot next year will not be much bigger.

What it means is showing the leadership necessary, and taking the accountability required, to invest that money in the changes that will make the system sustainable… so that health care costs grow at a manageable rate, and patient care is secure for generations to come.

We must together have the discipline to acknowledge that transforming health care so it lasts, so our children and grandchildren can count on it being there for them, means a re-prioritization of existing means instead of a kind of reflex increase – and a big one at that – year after year.

Leadership, and accountability.

We are showing these things on the issue of hospital funding, and we need no less from you.

I know it involves a big change in culture.

Previous governments have in a sense rewarded inefficiency by going along with a cycle of deficit, funding increase…  deficit, funding increase… year after year after year, all the while ignoring one pressing reality.

It's time to break the cycle.

Surely none of you would deny that it makes sense to break that cycle.

There isn't a person in this province who would look at a rent or mortgage increase – just for example – of 10 percent a year, year after year, and not "think wait a minute…this makes no sense. It's just not sustainable."

No household, no business, could sustain such increases, and neither can health care.

We have to break that cycle.

And we are. We did cover the deficits from last year. And we did give hospitals a funding increase. But… from here on out we are on one path – with one clear destination: balanced budgets.

We must get the spending curve under control, and we must demonstrate to the people of Ontario that they are getting what they need in return for the tax dollars they're investing.

That was the thinking behind interim accountability agreements, and I am pleased to see that most hospitals have taken them very seriously. Several IAAs are on their way to being approved.

As for the Balanced Budget Plans, those are coming along as well. There are many thoughtful and implementable initiatives contained in the BBPs we have received. There are all sorts of opportunities in those plans – and we welcome them – for us to work together.

I think it is a tribute to the hard work that you, your staff and trustees have done that the BBPs were completed as fast and as well as they were.

Having said that, there is no question looking at some of the plans we have received that this is going to be a difficult process - that we have a lot of hard work ahead of us – but I can only say what I have said all along :

There isn't any choice.

Growth must be constrained, and wage expectations have to be tempered to respect an era of restraint.

I think we have to acknowledge that it is time to look at the kind of program consolidation that can result in better clinical outcomes and more efficient services.

And to the hospitals who say it can't be done, I say look to the hospitals who have already done it.

Cambridge Memorial…  Dryden Regional Health Centre…Toronto East General…  Renfrew Victoria Hospital

I could go on. There's quite a list.

These are hospitals that have found efficiencies… have consolidated services… streamlined operations… shared IT services with neighbouring hospitals.

As we go forward, our system of Local Health Integrated Networks will be a big help in these efforts. They will encourage and facilitate working in partnership, sharing best practices, to deliver the best outcomes for patients in an efficient and sustainable manner.

We will also achieve those things by cultivating centres of excellence, by celebrating and encouraging the areas of expertise unique to different hospitals. You have all read the research linking volumes to outcomes. There are hospitals that simply do certain procedures better than anyone else because they have done so many of them for so long.

And so the University Health Network is a centre of excellence for heart and lung transplants.

The Children's Hospital of Eastern Ontario is a centre of excellence for children's mental health.

And just as the quality of service goes up the more you do, so too does the cost of these services go down. The infrastructure has been developed to provide these services better, and more efficiently.

There are ways, in other words, to run this system more efficiently.

We will work with you, collectively and individually, to help you find them.

At your request, we extended the time frame for balancing. We have instigated a seven step process to reduce deficits, and implemented a process to help you do it. It begins with consultations, moves on to joint committees of ministry officials, hospital executives and outside experts, and concludes with "turnaround" teams for those hospitals facing the most severe challenges.

Let me also say that we are not unaware that different hospitals face different unique challenges… that small and rural institutions have their own set of difficulties…that Academic Health Science Centres face specific fiscal demands.

All hospitals face inflationary pressures.

We are not unaware, and we will not ignore these realities.

But I need to be clear, again, that we mean what we say :

We will reward efficiency, but not inefficiency.

And while we remain open to ideas about so-called "transformation funding", let me be emphasize that, as a matter of principle, any such funds would be one-time funds.

Otherwise we are simply propping up an unsustainable system. And that we will not do. We are out to change the system.

Now the yardstick by which many Ontarians are going to measure that change will be wait times.

The fact is that in too many cases in Ontario, patients wait too long for tests and treatments, and this understandably shakes their confidence in the system.

We are going to restore that confidence.

A couple of weeks ago I had the pleasure of addressing the OHA wait times conference.

I was able to give an overview of our thinking on wait times, and how we are going to bring them down. I'm not going to repeat all of what I said there, but the central point that I made is one I want to repeat :

Wait times are a symptom… not a disease.

Wait times are a symptom of problems in access management. It is as simple as that. It might not be easy, but it is simple. If you improve access, you reduce wait times.

I am very proud today to announce our government's Wait Time Strategy… a strategy that will provide patients with better, faster access to medical services that will ease their pain and suffering, and in some cases save their lives.

We are kick-starting that strategy with an investment of $107 million this year, to reduce wait times in five key areas.

In September I announced the creation of our Health Results Team, led by Hugh MacLeod. This team is responsible for leading the implementation of our transformation agenda, from primary care reform to information management.

The member of that team responsible for wait times is Dr. Alan Hudson. It is Dr. Hudson's job, working with an Action Group of national and international experts, to improve access, and reduce wait times.

And I have to tell you, he and Dr. Peter Glynn have received so much support from the OHA that I believe we are poised for collective success.

Our strategy begins with the five areas that the people of Ontario have told us require urgent attention. They are areas associated with a high degree of disease and disability.

We're going to get people faster access to cardiac procedures, cancer care, hip and knee replacement, cataract surgeries and MRIs.

I want to be clear that these will not be our only priority… they are simply our first priority. The goal is to use the lessons from working on these five areas and apply them across the whole spectrum of health care.

This year's funding will be used in the following ways :

• We will establish a $50 million equipment fund to replace older MRI and CTs with newer equipment to improve quality and productivity.
• We will spend $5 million increasing the hours of MRI operations. This builds on our previous funding of nine new or expanded MRIs, four of which are already up and running.
• $14.5 million to fully fund an additional 1680 hip and knee replacements.
• $4 million to fully fund 805 cardiac surgeries, part of the additional 7,851 cardiac procedures that will be done this year.
• We will spend $10 million on improving access and increasing volumes of cancer surgery,
• And we will fund 2000 new cataract surgeries this year.

I think it's important to note that we are not just providing better, faster equipment in order to enable more procedures. We are also covering operating costs – human resource costs such as surgeons' and anaesthetists' costs, operating room time, so forth – in order to make sure the procedures get done.

These measures will reduce wait times – every Ontarian receiving quicker service will offer proof of that. But simply throwing money at increasing service volumes is the rough equivalent of prescribing aspirin. You're getting rid of the headache – temporarily – but you're not doing a thing to solve whatever caused it.

Treating the symptom is necessary and good, but any doctor knows the job isn't done until the disease has been cured.

Curing this disease means improving access, and that's really what our Wait Time Strategy is all about.

We're going to have a province-wide web site up and running within months. It will be a work in progress, evolving with – and marking the progress of – our wait time strategy. It will eventually display wait times in each of the five key areas. The more Ontarians know about the wait time situation, the more empowered they will be to hold the government, and the health care system to account.

Leadership and accountability.

We will immediately begin collecting information about our progress on wait times. This will be an evolutionary process. By the end of 2006 we will have developed a comprehensive provincial registry that displays wait times in our five key areas to the public and gives us all the information we need for better program management.

Going forward we will eventually be collecting and reporting information about wait times for every operation done in this province.

Our investment will be used to encourage greater efficiency through innovation, education, better equipment and standardization of best practices.

It will also support the development of a consistent method of prioritizing patients. Dr Hudson and his team will not only be determining how long Ontarians are waiting for certain procedures, they will be lending their leadership and expertise to the development of benchmarks for how long people should be waiting.

That will allow them to develop a plan to ensure that all Ontarians are receiving equitable access to health care, in a timely manner.

In the course of this process we will be building on our strengths.

The Cardiac Care Network, Cancer Care Ontario, and the Ontario Joint Replacement Registry have all made significant progress in charting, reporting, and reducing wait times.

We will build on those successes in setting up a province-wide – and health system-wide – plan to combat wait times.

Through it all, we will be reporting back to Ontarians via the Ontario Health Quality Council.

This will be our primary tool for reporting to the public on how we are delivering on all of our health priorities, including access, health status, health system outcomes, and of course wait times.

The Council will be up and running by next summer, and will release its first report to Ontarians before the end of the year.

Our Wait Time Strategy is only the beginning. It is something we will build on in years to come, as we deliver on our promise to Ontarians to improve their access to the services they rely on.

The end result will be restored public confidence, and a Public Medicare system whose success we can all celebrate together.

The deal signed in September between Ottawa, the provinces and territories signaled what I believe is the start of an important era in health care in this country. We have the will, and some of the means, to accomplish great things.

Another way we must address wait times is by upgrading our equipment infrastructure.

Today I am announcing one third of a billion dollars to do precisely that.

Our government will flow up to $334 million in diagnostic medical equipment funding, much of it to Ontario's hospitals. This strategic allocation will be used to make our system more modern and efficient.

Patients, of course, will be the major beneficiaries.

I will have more to say about our DME fund in the weeks to come.

Some of you may know that I'm a hockey fan. Those of you who share my passion will know that I'm hurting these days because of the lockout.

I'm also hurting because of my recent tryout with the Barrie Colts. It was organized by Rob Devitt.

They were very nice about it, but they told me I might not want to give up my day job.

I told them it might not be up to me.

But anyway, with apologies both to those of you who miss hockey, and those of you who don't like the game, I'm going to pick up on an analogy I used in concluding my remarks to you last year.

I said that we were guilty of watching the puck. We still are. We're doing better than we were a year ago, but we still have our heads down too much of the time… we're not seeing the whole ice surface.

At best when you do that, you miss the opportunity for the winning goal. At worst, you never see the hit coming that knocks you flat.

We have 12 million people counting on us to play as a team… counting on us to see beyond our short-term concerns and see the bigger picture.

Whatever differences we have pale in comparison to the objectives we share.

We have accomplished a lot, together, in the past year.

I can say without a trace of irony that I very much look forward to coming back a year from now to talk to you again… because I know we will have accomplished a whole lot more.

Leadership involves leaving things better than when you found them, and I am determined to do exactly that in health care.

I have said this many times before, but we inherited a system that isn't actually a system. It's a collection of silos, many doing great work, but too often doing that work in isolation.

We have a vision that extends beyond those silos, to an integrated health case system where the component parts – doctors, nurses, Family Health Teams, community health services and of course hospitals – work together in a comprehensive, efficient manner that has one simple ultimate goal : better patient care.

Leadership and accountability. I promise you those things, and based on a year of getting to know you, I am confident in expecting the same in return.

Thank you.