Good morning. Welcome to Queen's Park, and to my riding of Toronto-Centre-Rosedale.

I'm delighted to be here at this, the 6^th annual RNAO Day at Queen's Park, and the second I've had the pleasure of addressing as Minister of Health and Long-Term Care.

I note that as we enter our second full year in government, nurses in this province are entering their second century as an organized profession. It's a useful reminder to me that the things that are truly important have lasting power …

… which may also explain why I'm so devoted to the Toronto Maple Leafs.

I want to tell you that I believe RNAO Day to be a very important, valuable event. It's great when education and advocacy are organized to help patients rather than at their deliberate expense.

It is an opportunity for those of us here at Queen's Park to thank the RNAO for the superb leadership you have shown, and continue to show, in representing this province's registered nurses. Joan, Doris, Irmajean and the Board and staff of RNAO, you are a passionate and valued voice on health policy.

What I appreciate about the RNAO is that you show up for work every day, and you always show the tenacity that only those who are truly committed can consistently muster.

I know I'm not alone in thinking that. My colleagues John Tory and Howard Hampton will be speaking after me, and I'm sure they'll tell you the same thing.

So as I say, this is a good opportunity for us, but it is also a good opportunity for you.

You're going to get to listen to me, to hear what my government is doing, and has done, to transform health care in this province, and to hear what we're doing, and have done, with respect to the nursing profession.

And then you're going to get to listen to my colleagues, Mr. Tory and Mr. Hampton. It should make for an interesting comparison.

I would urge you to listen closely, both to what they say, and to what they don't say.

You're going to hear Mr Tory criticize us at length. Lord knows, if he gets his dander up he may even use the word incompetent.

But what you won't hear him talk about is the fact that his party, while in power, fired thousands of nurses, only to hire them back at a cost of $400 million.

And I doubt he'll mention the fact that his former party leader, Mike Harris, compared nurses to the hula hoop fad.

I also doubt he'll have very much to say about where he's going to find the $2.4 billion he's promised to take out of health care …

… which is a shame, ’cause I'm sure we'd all love to hear the answer to that one.

As for Mr. Hampton, I'm quite certain he'll be brimming with indignation about the terrible things we're doing to health care in general and nurses in particular …

… but he won't say much about the 3,600 nursing jobs that disappeared on his watch, or the thousands of nurses who saw their wages frozen or rolled back, arbitrarily, again on his watch.

And neither John Tory nor Howard Hampton will have anything positive to say about the $3 billion worth of health care investments we've made in the past year, or about the unprecedented commitment we've made to nursing …

… and that's okay.

It's not their job to give us credit, and I wouldn't expect it of them.

However, with particular respect to what we have done for nurses in the province of Ontario, we do care, and deeply so, about the recognition we get from you, the nursing leaders in this province.

Because I genuinely do not believe that there has been an Ontario government in recent memory who was as committed as we are to revitalizing Medicare in this province, as envisioned by Roy Romanow..  And embedded in our plan to do this is a profound commitment to the nursing profession.

• We have promised to have 8,000 new nurses practicing in the province by the end of our mandate.
• We have set a target of 70 percent full-time employment, and we are backing it up with action. When I visit hospitals these days, the first thing CEOs want to talk to me about is how many nurses they have working full-time. This is reflective of a major cultural shift.
• We have a strategy to recruit and retain nurses, from new grads to mentors, using ideas suggested by the RNAO.
• We are providing a safer environment for nurses and patients, by investing in bedlifts and in clinical simulation equipment at nursing schools.
• This past year, we funded 2, 914 new full-time nursing positions in our hospitals, long-term care homes, home care and community agencies.
• That's 1,064 in hospitals
• 600 in Long-Term care Homes
• 250 in home care and community mental health
• And a further 1000 temporary full-time positions for new graduates in our hospitals and Long-term Care homes

The very first meeting I had upon becoming Minister was with representatives of the RNAO. That is because it was clear to me then, as it is even clearer to me know, that nurses are the heart and soul of health care.

From Kenora to Attawapiskat, from Hawkesbury to Windsor, I have thrived in the privilege of simply thanking our nurses for their dedication.

The fact is, nurses are there with us– and for us – in virtually every health care setting we encounter. We believe wholehearedly that a strong public health care system depends upon a strong nursing profession.

We know that any serious attempt to improve that system must begin with restoring the foundations of nursing, increasing the number of nurses, providing them with more full-time opportunities, and improving the conditions under which they work …

… and we are doing exactly that.

From Bill 8, that laid the groundwork for the Accountability Agreements that will guarantee more full-time employment for nurses …

… to the 150 Family Health Teams that are in large part going to be built around – and dependent on – the skills of nurses and nurse practitioners …

… or our raising of standards in Long-Term Care homes, not to mention funding 2,000 new front-line staff, including 600 new full-time nurses.

I could go on and on. The fact is that after more than a decade in which nurses were ignored by government more often than not, we have set out quite deliberately to enlist your help and participation in changing the health care system for the better …

… better for patients, better for doctors, and better for you.

And let me be crystal clear :

We can't get where we want to go without you.

We can't transform health care without you.

We can't make health care sustainable without you.

We need more of you. We need you happy. We need you healthy. We need you working. Period.

But to get there, we will also sometimes require your patience. And I'm asking for it now.

I'm referring, of course, to this past week – to the war of words that has erupted over the hospitals' Balanced Budget Process, and the effect it will have on nursing.

It has been suggested that a government that prides itself on its commitment to hire new nurses shouldn't be condoning a reduction in nursing hours.

So let me try to address the issue of FTEs full on.

First, let's be honest here. When I spoke last week about the fact that some hospitals are estimating a reduction in nursing hours in some of their units, this did not mean that they are going to turn around tomorrow and lay off nurses.

We expect – and will in fact ensure – that hospitals will in every possible case find these hours through reductions in overtime – and overwork – hours, agency hours and voluntary retirement.

So we really don't know how many layoffs there'll be.

We do know that some of these hours will not be hours lost to a hospital or to the hospital sector, but will represent nurses moving from one section of the hospital to another where there is greater need.

The collective agreement stipulates that when a nurse is moved from one section of a hospital to another – as might surely be expected to happen in the midst of all these changes – that is technically a layoff.

What we also know is that there will naturally be nurses working in hospitals today who will in the future be working in the rapidly growing community health sector in which our government has invested so heavily.

And I want to say that both our government and nursing leaders have a collective responsibility to ensure that nurses have the proper support to make the transition into different types of nursing practice.

You will see health human resources take on a more prominent role in government soon. There will be an increased effort to ensure that we have the right number of nurses and other professionals with the right skills and the right knowledge in the right place for patients as we continue to transform health care in this province.

Ladies and gentlemen, you have heard my arguments supporting the transformation of health care many times.

More than $30 billion – nearly half of the money spent by the provincial government – goes to health care. And that figure has been growing at an average rate of 8 percent a year for the past four years.

Hospital funding, at $11.3 billion, is the largest single line item in the government's budget. And it's been growing at 10 percent a year, year in and year out.

All of this at a time when the economy was only growing at about 3 percent.

You have heard me say that for much too long, hospitals have been asked to take on too much, to carry much more than their share of the health care burden.

They have by default become a one-stop shop for almost every health care service – something they were never designed to be, nor could they afford to be.

You know all this. We know all this.

And the previous government before us knew it as well but they still funded hospitals at 10 percent a year while neglecting community-based health, starving home care, public health, long-term care homes, community health centres and mental health agencies.

They left us to do the job, and we are.

We are making the necessary investments in community-based care, and we are forcing hospitals to become dramatically more efficient, by focusing their resources more directly into patient care …

… and that, I am sorry to say, inevitably means that there will be some adjustments in human resources.

But the changes hospitals are making are part of an overall plan for health care that is going to result in an improved system, with more nurses working across Ontario.

This is key, and it seems to have got lost in translation somewhere along the line :

There will still be a net gain in nursing employment in hospitals this year, thanks to the millions of dollars we have invested to hire more nurses. And more of the employment will be of the best kind – full-time, secure jobs for new nursing grads and experienced nurses alike.

And let me be clear that we are holding hospitals to account for creating those jobs.

Our Accountability Agreements will spell out in clear language that hospitals must create more full-time nursing positions with the goal of reaching 70 percent. If hospitals don't use the targetted funding in the prescribed manner, we will take it back and give it to hospitals that will.

Nursing plans must be signed off on by Chief Nursing Officers and union reps, confirming that funding for nurses was in fact spent on nurses.

And with the new powers we have given the Provincial Auditor under Bill 18, he or she will be able to open up the books and hold us both, hospitals and government alike, to account.

I also want to make it very clear that part of this process involves putting hospital CEO and senior management salaries under the microscope.

We have asked that those salaries be frozen, and increasingly we will be making efforts to bring them into line with other public sector entities.

Now before I go, I would like to make an important announcement that reflects what I was saying a moment ago about nurses having the tools they need to pactice in an ever-changing health care environment.

We are investing $150,000 to fund the Best Practices Institute proposed by the RNAO and the University of Ottawa.

This will have a mandate to research and explore the ways in which nurses can best evaluate, share and apply the various best practice guidelines that have been established for the profession.

The benefits are obvious…for nurses, and of course for the patients they care for so well.

So in conclusion, I am asking you, please, to work with us as you have done from the day we came to power.

We will continue to work through the Balanced Budget Process, as we have done since it started, to minimize the effects on nurses. And we will do so with continued input from nurses.

We will continue, as we have done from day one, to make investments in better work conditions for nurses, and in more nurses to do the work that needs to be done.

We will continue, as we have done from day one, to enlist the help of nurses in the shaping of important public policy, because nurses are leaders in our society and they need to be heard.

And we will continue, as we have done from day one, to transform this health care system of ours, working with nurses and all other health care providers to ensure that Ontarians continue to receive the health care they need …

… today, tomorrow, and for generations to come.

Thank you.