Dear Colleagues,

The topic of government spending in the healthcare arena has dominated our newspapers and television news for the past few days and has been a dominant media issue for months. The importance and sensitivity of this issue is demonstrated by the fact that the Auditor General's report on spending practices at e-Health Ontario led to the resignation of the Minister of Health and Long Term Care.

UHN is one of the largest recipients of public funds from the Government of Ontario and we are accountable to our Board of Trustees for spending those funds wisely and well. As you know, the Board serves to represent the interests of all of our stakeholders (patients and families, taxpayers, the Ministry, staff and others) in ensuring that we spend our healthcare dollars carefully. The Board considers this from two perspectives represented by the two major Committees of the Board. The Finance and Audit Committee determines that controls are present and appropriate to ensure that our revenues and expenditures are accounted for properly and that we manage our financial risks. The oversight provided by this Committee is facilitated by the continuous scrutiny provided by arms-length internal auditors who rigorously test our controls and results on a regular basis. The Quality Committee of the Board carefully reviews the quality of care that we provide with those funds and ensures that we have processes in place to manage our clinical risks.

The oversight provided by the UHN Board of Trustees is robust and knowledgeable. As the manager ultimately responsible for the expenditure of public funds at UHN, I am pleased that we have such strong and experienced Trustees to hold management accountable for our performance. This oversight is healthy and effective.

However spending public funds for healthcare is a sacred trust and we can never do enough to ensure that we are using those funds appropriately. Senior Management is currently evaluating all aspects and policies related to spending through our hospitals. We have done a major benchmarking exercise of the "Model of Care" that we use in our in-patient units across UHN and PMH is doing a review of their Ambulatory Care processes. Management is also reviewing policies related to non-clinical spending. We are learning from all of these reviews and will likely introduce some new policies and guidelines around spending controls. However we have not discovered anything that has surprised me or upset me- our financial controls are very solid- while there is always room for improvement- our reviews of spending have not shown that major changes are necessary.

The economic realities and the political situation facing the Government of Ontario suggest that public spending will be tightened within healthcare and the public sector over the next few years. As you have seen in the themes we are developing for UHN's new strategic plan, achieving improved value for our patients will be an important element of our work over the next few years. I feel a strong sense of personal responsibility for ensuring that dollars spent at UHN are dollars spent wisely. I know from comments that I have received from staff that you agree that this is the right attitude.



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