Local Health Integration Network. Chair & CEO Joint Meeting

Transcription

1 Local Health Integration Network Chair & CEO Joint Meeting Jim McCarter Auditor General September 20, 2007

2 To Discuss Today Some background on the Auditor General s Office Value-for-money auditing process Role of LHINs in Health BPS Audits 1

3 Independence of the Auditor As an Officer of the Assembly, the Auditor General is independent from the government. The Legislative Assembly is the Office s client. The Auditor General is only removable for cause by the Lieutenant Governor in Council on address of the Assembly. This allows the Auditor to have the independence to be critical of the government of the day if necessary. The Auditor has a 10 year non-renewable term. 2

4 What Is Primary Job Of The Auditor General Provide information to the Legislature to help it ensure taxpayer funds are prudently spent and government administrators follow sound business practices. Encourage improvements in the way governments deliver public services (better and more cost-effective service delivery). Traditional auditor role - provide assurance that financial accounts are fairly presented. 3

5 Size of Office Office s annual estimates approved by the all party Board of Internal Economy In comparison to the other large provincial audit offices: Population Office Budget $ Staff Quebec 7.6M 21.4M 223 Alberta 3.2M 17.7M 122 Ontario 12.5M 14.0M 115 BC 4.2M 13.0M 101 4

6 What Types of Audits does the Office do? Public Accounts 5% Agency F/S audits 20% I.T audits 5% PAC or Minister special assignments 3% Value-for-money audits 67% Value-for-money audits Agency F/S audits Public Accounts I.T audits PAC or Minister special assignments 5

7 VFM Audits Members of the Legislature want information to assist them in holding the Government and its administrators responsible for the spending of public funds and delivery of services. Focus is on how cost-effectively a government program (or entity) is operating and the level of service being provided. In Ontario, the Standing Committee on Public Accounts generally only holds hearings on VFM audits. 6

8 Financial Audits A Financial statement auditing provides information on where taxpayer funds are being spent but it does not provide information on whether funds are being well spent Testimony at Bill 36; Local Health System Integration Act Committee Hearing (why you have Deloittes & not the A.G. 7

9 Ministry Health Audits Last 5 Years Outbreak Preparedness Ontario Drug Benefit Program OHIP Ambulance Services Land Ambulance Services Air 8

10 Ministry Health Audits Last 5 Years Health Laboratory Services Recovery of Health Costs Resulting from Accidents Community-based Services Independent Health Services Public Health Activity 9

11 Auditor General Act Recently Amended Expansion of value-for-money auditing to organizations in the broader public sector, such as hospitals, colleges, universities and school boards and other organizations receiving government grants. (Effective March 2005) 10

12 2007 Hospitals Management & Use of surgical facilities LTC Drug Administration and management & 2006 Health Sector BPS Audits Hospitals Administration of Medical Equipment Hospitals Management & Use of CT s and MRI s 11

13 2006 Hospital Audits Experts Consulted Some of experts consulted: Institute for Clinical Evaluation Sciences Canadian Institute for Health Information Imaging Hospital for Sick Children Radiologist specialists Canadian Association of Radiologists Ontario Association of Medical Radiation Technologists Healing Arts Radiation Protection Comm. College of Physicians & Surgeons Clinical practice paramedic Ministry s expert panel on MRI & CT 12

14 Audit Process % Research and planning / develop audit criteria & programs 25 Visits to organizations to conduct field work 50 Assessing / Draft reporting process 20 Internal / external clearance 5 13

15 Reporting Process (BPS Audit) 1. Oral exit at each organization 2. Summary (no-names) draft report discussed each organization 3. Responses to recommendations summarized 4. MOHLTC input / responses 5. Final draft to CEO s and DM 6. Annual Report released early December 14

16 Possible Involvement of LHINs in BPS Health Audits LHINs soon responsible for funding BPS organizations LHINs responsible for primary oversight $ and service delivery LHINs have service / performance agreements with organizations and MOHLTC Minister ultimately accountable in Legislature 15

17 Factors to Consider Organizations, i.e. hospitals want autonomy to discuss auditor s recommendations / draft report before MOHLTC / LHIN involvement. Some recommendations may require Ministry and / or LHINs involvement. Minister & LHIN Chairs / CEO s may face questions when Annual Report released. 16

18 Proposed Involvement to Discuss Draft report cleared hospitals first Regional LHIN CEO of audited organization receives draft same time as MOHLTC DM DM & LHIN CEO prepare joint response to any recommendations affecting LHIN or Ministry / concerns over factual accuracy, etc (likely ADM LHIN CEO s) 17

19 Proposed Involvement to Discuss Final draft to hospital CEO s, Health Deputy Minister & affected CEO s only Recommend brief full LHIN Board but not provide copy Report section not distributed to all LHINs until AR released 18

20 Audit of LHINs Relatively small ($3 5 m per LHIN) If an audit I suspect focus would be on effectiveness of Mty / LHIN oversight / monitoring of hospitals accountability, $, service delivery not on individual LHIN operations (i.e. audit of LHIN salaries, purchases, etc.) 19

21 Thank you and Any Questions? Office of the Auditor General of Ontario, Canada 20