OTTAWA — A year after first ministers signed a $41-billion health accord that was supposed to fix medicare for a generation, health-care providers say they've seen little evidence the promised reforms are being implemented.

"Canadians have been left wondering whatever happened to the promise shown by the health plan," Dr. Ruth Collins-Nakai, president of the Canadian Medical Association, said at a news conference Thursday.

But Prime Minister Paul Martin insisted progress on the health accord is being made, citing the appointment of wait-time adviser Brian Postl.

"Wait times are the canary in the coal mine, they are the way in which one can determine whether reforms are required," he said at a news conference in New York.

"Our focus this fall is going to be on wait times and that's why Dr. Postl was appointed."

Health Minister Ujjal Dosanjh said the commitments of the accord are being implemented.

"Wait times are being reduced in different areas, investments are being made, whether it's in equipment or other areas, thousands of additional surgeries are being produced."

Associations representing doctors, nurses, pharmacists and hospitals all criticized what they called the lack of apparent results from the massive federal cash infusion.

Deborah Tamlyn, president of the Canadian Nurses Association, said provinces have not yet established plans to increase the supply of doctors, nurses and other health professionals.

"Major shortages loom, and efforts to reduce shortages are moving at a snail's pace. We rely too heavily on part-time staff. We need a people plan now."

The accord included promises to bolster home care, but so far Ontario is the only province to provide new funding for home or community care, Tamlyn said.

Jeff Poston, executive director of the Canadian Pharmaceutical Association, lamented slow progress on a promised pharmaceutical plan that would cover catastrophic drug costs.

Sharon Sholzberg-Gray, president of the Canadian Healthcare Association, questioned whether provinces will establish wait-time benchmarks for five key medical procedures by Dec. 31, as specified in the accord.

She said she is worried that provinces will each establish their own benchmarks, preventing interprovincial comparisons. That would defeat the purpose of the exercise, to highlight outstanding performers and expose laggards.

"It ought to matter to Canadians that there is some comparability," said Sholzberg-Gray. "At the end of the day the role of the federal government is to ensure that comparability."

But Dosanjh seemed to suggest separate sets of provincial benchmarks, without comparability, might be acceptable.

"We will do everything possible as a federal government to try and nudge, cajole, encourage all of the jurisdictions to get there together or on their own by Dec. 31, 2005," he said.

A new poll commissioned by the Canadian Medical Association and the Canadian Nurses Association suggests that half of Canadians are less optimistic about the future of health care than they were a year ago.

Only one in three of those polled were confident governments will follow through on the commitment to agree on medically acceptable wait times for key medical procedures by the end of the year.

The majority said Ottawa should withhold increased health funding if provinces don't meet their commitments.

The Ipsos-Reid survey of 1,001 adult Canadians was taken between Sept. 6 and Sept. 8. The polling firm says the results are accurate to within 3.2 percentage points, 19 times out of 20.

Dosanjh dismissed the idea of withholding money if provinces fail to uphold their commitments under the accord.

"This is not an ordinary contract. This is an extraordinary contract entered into by the first ministers of the country. Those kinds of contracts depend upon trust and I trust the provinces to do the right thing."

NDP Leader Jack Layton said the government is showing a failure of leadership.

"They're just not moving with a sense of urgency," he said in Halifax. "I think they assume once they've announced the big bucks, then they can move onto the next issue of the day."