Office of the Auditor General of Ontario Annual Follow-Up on Value-for-Money Audits Annual Follow-Up on Value-for-Money Audits Value-for-Money on Annual Follow-Up December 2020 December 2020 Office of the Auditor General of Ontario To the Honourable Speaker of the Legislative Assembly In my capacity as the Auditor General, I am pleased to submit to you my Annual Follow-Up on Value-for-Money Audits volume of the 2020 Annual Report of the Office of the Auditor General of Ontario to lay before the Assembly in accordance with the provisions of section 12 of the Auditor General Act. Bonnie Lysyk, MBA, FCPA, FCA Auditor General Fall 2020 Toronto, Ontario Table of Contents Reflections 5 Summary 8 Chapter 1 Follow-Up Reports on 2018 Annual Report Value-for-Money Audits 16 Section 1.01 Assistive Devices Program 19 Section 1.02 Darlington Nuclear Generating Station Refurbishment Project 32 Section 1.03 Health Quality Ontario 45 Section 1.04 Interprovincial and International Health Services 60 Section 1.05 Legal Aid Ontario 72 Section 1.06 Metrolinx—GO Station Selection 86 Section 1.07 Metrolinx—LRT Construction and Infrastructure Planning 93 Section 1.08 MRI and CT Scanning Services 113 Section 1.09 Office of the Public Guardian and Trustee 128 Section 1.10 Ontario Student Assistance Program 143 Section 1.11 Ontario Works 158 Section 1.12 School Boards—IT Systems and Technology in the Classroom 180 Section 1.13 Technical Standards and Safety Authority 197 Section 1.14 Use of Consultants and Senior Advisors in Government 214 Section 1.15 Waterfront Toronto 225 Section 1.16 Public Accounts of the Province 238 Chapter 2 Follow-Up Reports on Special Reports Section 2.01 Niagara Peninsula Conservation Authority 243 Chapter 3 Follow-Up on Reports Issued by the Standing Committee on Public Accounts 269 Section 3.01 Cancer Treatment Services 273 Section 3.02 Darlington Nuclear Generating Station Refurbishment Project 295 Section 3.03 Ontario Works 300 Section 3.04 Public Accounts of the Province 309 Section 3.05 Public Health: Chronic Disease Prevention 313 Section 3.06 Real Estate Services 324 Section 3.07 Review of Government Advertising 333 Section 3.08 Settlement and Integration Services for Newcomers 335 Chapter 4 Follow-Up on Audit Recommendations from 2013 to 2019 345 iv Reflections Bonnie Lysyk Auditor General of Ontario On March 17, 2020, the government declared a and the organizations in the broader public sector state of emergency due to the COVID-19 pandemic. that we audited agreed to implement, were either Immediate actions had to be taken to reduce not implemented or implemented only temporarily, the spread of the virus. To tackle this pandemic with the improved practices not maintained. head-on required effective systems and processes We make recommendations each year in our to be in place. However, many challenges were value-for-money audits after spending consider- encountered, and the weaknesses in the systems able time with these organizations reviewing how that needed to be relied upon were amplified— they deliver their programs and services. We look weaknesses that our Office has commented on in at improvements that can be made in areas such many prior audit reports where recommendations as accountability and transparency, operational were made for improvements and changes. Some of efficiency and cost-effectiveness, and compliance these recommendations highlighted the need to: with applicable legislation. A central focus of our • improve the province’s preparedness to work with the organizations we audit is whether respond to future pandemics; the resources they use are achieving the desired • update emergency management plans of the outcomes, and how these organizations can better province and ministries (including that of the serve Ontarians. Ministry of Health); Once we conclude our audit work, we issue • replenish the province’s expired inventory of value-for-money reports that contain consider- personal protective equipment; able information about the subjects we audit, • strengthen inspections and address other and a series of recommended actions addressed issues in long-term-care homes, including to senior decision-makers in ministries and the the handwashing practices for residents and broader public sector. These recommendations are those who feed residents; a critical part of our audit reports; we believe that • improve the IT systems for capturing public implementing them is important to drive positive health information; improvements in the delivery of programs and ser- • address public health governance issues and vices for Ontarians. varied practices; The audit process seeks input and agreement on • expand the lab testing capabilities at Public these recommendations from senior management Health Ontario; and in the organizations we audit before we finalize • address weaknesses in the province’s immun- our reports. After we table our reports, therefore, ization system. we operate with the shared understanding that However, many of our recommendations in those responsible will take the necessary actions to these areas, which the ministries, Crown agencies make the improvements they committed to within a 5 6 2020 Follow-Up Report reasonable period of time. Yet just as we expect the of being implemented when we follow up after two timely implementation of our recommendations to years. This too may be reasonable if the recom- have positive results, we are also aware of the poten- mended actions are complex and may take longer tial negative impacts on Ontarians when implemen- to put into effect. tation of our recommendations lags or when they In cases like these, our Office takes its respon- are not implemented at all. Some of the weaknesses sibility to follow up several steps further—we ask in provincial systems and processes that revealed what becomes of these recommendations that we themselves and were amplified during the last eight found to be only partly implemented when we were months are an unfortunate testament to this. preparing our two-year follow-up reports. Is prog- For many years, our Office has issued follow-up ress still being made toward fully implementing reports two years after publication of the original them? The answer comes through further investiga- report to assess the progress made in implementing tion and inquiry to verify whether the organizations the actions we recommended. This year we fol- we have audited are still committed to completing lowed up on 17 audits completed in 2018 and found the work they undertook to do years earlier. that 42% of the actions had been fully implemented This is why four years ago we set up a team with (compared to 32% in our 2019 Annual Report); the responsibility to follow up on our recommenda- 30% (2019—37%) were in the process of being tions older than two years, beginning with recom- implemented; for 25% (2019—27%) little or no mendations from our 2012 Annual Report. The progress had been made; and 3% (2019—4%) were team’s expanded follow-ups have let us see patterns either no longer applicable or no longer planned in how organizations address our recommenda- to be implemented (see Chapter 1, Figure 1). This tions. In particular, we have found the following: year we saw improvement in the two-year imple- • As time passes, more recommended actions mentation rate of recommendations stemming are implemented, but at a slow rate. The mainly from these audits: Metrolinx—GO Station average full implementation rate for recom- Selection; Use of Consultants and Senior Advisors mended actions issued between 2013 and in Government; Assistive Devices Program; Water- 2015 is 35% after two years and 62% after front Toronto; Technical Standards and Safety five years. This indicates an average increase Authority; Interprovincial and International Health in full implementation of 27% between two Services; and Niagara Peninsula Conservation and five years. However, our experience to Authority. Our 2018 recommendations for MRI and date indicates that there is only minimal CT Scanning Services, Ontario Works and Health progress on recommended actions after the Quality Ontario have had the lowest implementa- five-year mark. tion progress by the responsible ministries. • While full implementation rates slow down Our aim in following up this way is to see that as time passes, work continues to be done these actions are fully implemented or, if we are on getting to full implementation. In 2020, told this has not been possible, to understand why organizations told us that they were in the and to report on the reasons to Ontarians. For process of implementing approximately 25% instance, sometimes, a recommendation may no more of the recommended actions from 2013 longer be applicable—for example, if there have to 2015, five to seven years later. been policy and program changes since our report • For recommended actions issued in 2016, was issued. This is reasonable and expected. At 2017 and 2018, we have seen an average other times, some alternative actions meet the two-year full implementation rate of 35%, a intent of our recommendation and we conclude rate consistent with that experienced for 2013 that our recommendation has been implemented. to 2015. In 2020, organizations told us that Other recommendations may still be in the process approximately 37% more of the recommended Reflections 7 actions from those years were in the process issued between February 2019 and February 2020. of being implemented and that another 17% This year, we found that 62.4% of recommenda- where there had still been little or no progress tions were either implemented or in the process would nonetheless still be implemented. of being implemented (83% in 2019). This year’s • When we conduct our follow-up work, we implementation rate was negatively impacted by find that some organizations misrepresent the low implementation rate for the recommenda- their progress in fully implementing recom- tions in the report on Ontario Works, which was mended actions.