Reports
Health 2019
This report focuses on key observations and findings from the most recent financial audits of the Ministry of Health, local health districts, specialty health networks, health corporations and independent health agencies in New South Wales. The report also summarises self-reported performance measures across the network.
The number and value of adjustments to financial statements of entities in the Health Cluster decreased from the prior year. And unqualified audit opinions were issued for all heath entities’ financial statements.
Audit findings relating to internal controls deficiencies increased across health entities. Contributing to this increase were deficiencies in information system controls, which accounted for nearly a quarter of all control deficiencies. Repeat audit findings also accounted for more than a quarter of all control deficiencies.
The report notes health entities continued to experience challenges with managing employees’ excessive annual leave and time recording practices. The Ambulance Service of New South Wales continued to report high overtime payments to its employees.
This report analyses the results of our audits of financial statements of the agencies comprising the Health cluster for the year ended 30 June 2019. The table below summarises our key observations.
1. Machinery of Government changes
| Cluster changes | Machinery of Government (MoG) changes refer to how the government reorganises agency structures and functions and realigns ministerial responsibilities. The Health cluster was not impacted by the MoG changes. |
2. Financial reporting
| Financial reporting |
The financial statements of NSW Health and its controlled entities received unqualified audit opinions before the legislative deadline. |
| Financial performance | Overall, NSW Health recorded an operating surplus of $1.1 billion in 2018–19, an increase of $699 million from 2017–18. This was the result of additional funding received for capital expenditure on the construction of new facilities, upgrades and redevelopments. Budgeted expense for the 15 local health districts and two speciality networks increased from $18.3 billion to $19.4 billion in 2018–19. The 15 health entities recorded unfavourable variances between actual and budgeted expenses. |
| Excess annual leave |
Managing excess annual leave remains a challenge for NSW Health, 36.9 per cent of the workforce have excess annual leave balances. Recommendation: Health entities should further review their approach to managing excess annual leave in 2019–20, and:
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| Overtime payments | NSW Health entities generally manage overtime well. The Ambulance Service of NSW’s overtime payments of $83.1 million (9.8 per cent of total salaries and wages), remain significantly higher than other health entities. Recommendation: The Ambulance Service of NSW should further review the effectiveness of its rostering practices to identify strategies to reduce overtime payments. |
3. Audit observations
| Internal control deficiencies | We identified more internal control deficiencies in 2018–19. The number of repeat issues from prior years also remains high with more than one quarter of issues having been previously reported. More than a quarter of deficiencies related to information system controls. |
| Infrastructure delivery | NSW Health defines projects with a budgeted cost greater than $50.0 million as 'major projects'. There were significant revisions to planned financial completion dates and budgeted costs of these projects. The revised total budgets for the 30 ongoing major capital projects at 30 June 2019 is $10.2 billion, $2.2 billion more than the original budget. Health Infrastructure completed three major capital projects during 2018–19. |
| Asset maintenance | The total cost of maintaining the health entities’ $19.8 billion of assets was $635 million for 2018–19. Health entities' approaches to setting maintenance budgets vary. Most entities are addressing their backlog maintenance, although many were not able to quantify the full extent of their backlog maintenance. Although health entities continue to use fully depreciated assets, the replacement cost of these assets is decreasing. |
This report provides parliament and other users of the financial statements of agencies within the Health cluster with the results of our audits, our observations, analysis, conclusions and recommendations in the following areas for the year ended 30 June 2019:
- financial reporting
- audit observations.
The Health cluster was not impacted by the Machinery of Government changes on 1 July 2019.
Financial reporting is an important element of good governance. Confidence and transparency in public sector decision making are enhanced when financial reporting is accurate and timely.
This chapter outlines our audit observations related to the financial reporting of agencies in the health cluster for 2019.
Section highlights
- We issued unqualified audit opinions for all health entities’ financial statements and identified fewer misstatement than last year. Health entities continue to meet statutory deadlines.
- The Ministry of Health sets significant accounting policies centrally and provides a template for the preparation of health entities’ financial statements. These processes promote consistent quality in the financial reports of health entities and reduce the number of misstatements we identify.
- NSW Health recorded an operating surplus of $1.1 billion, an increase of $699 million from 2017–18. This is because of additional capital grants for new facilities, upgrades and redevelopments. The capital replacement ratio (investment in new assets divided by depreciation) for NSW Health is 2.6.
- NSW Health’s expenses increased by 7.0 per cent in 2018–19 (5.5 per cent in 2017–18). This is one percentage point higher than the projected long-term annual expense growth rate of six per cent. The primary causes for the growth in expenses are increased:
- employee related expenses because provisions for employee benefits increased when the discount rate decreased
- operating expenses associated with the opening of Northern Beaches Hospital.
- Excess annual leave balances continue to increase for the NSW Health workforce, with excess annual leave balances impacting 37 per cent of employees (34 per cent in 2017–18).
- Health entities should further review their approach to managing excess annual leave in 2019–20 by monitoring current and projected leave balances on a regular basis, agreeing formal leave plans with employees and encouraging staff that perform key control functions to take a minimum of two consecutive weeks’ leave a year as a fraud mitigation strategy.
- The Ambulance Services continued to report overtime payments higher than other health entities. The Ambulance Service paid its employees $83.1 million in overtime payments in 2018–19 ($74.8 million in 2017–18).
- We issued a qualified audit opinion for the Ministry of Health's Annual Prudential Compliance Statement for aged care facilities operated by NSW Health. We identified 40 instances of material non-compliance with the Fees and Payments Principles 2014 (No. 2) (the Principles) in 2018–19 (17 in 2017–18).
Audit opinions
We issued unqualified audit opinions for all health entities and quality of financial reporting continues to improve
We identified fewer misstatements this year, and the errors were less significant. In 2018–19 no errors exceeded $5.0 million (eight errors recorded in 2017–18). Ten health entities conducted a full revaluation of their land, buildings and infrastructure systems in 2018–19, but more robust processes avoided the errors identified in the previous year.
| Number of misstatements | ||||||
| Year ended 30 June | 2019 | 2018 | 2017 | |||
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| Less than $50,000 | -- | -- | -- | 6 | 3 | 3 |
| $50,000 to $249,999 | -- | 1 | -- | -- | 2 | 3 |
| $250,000 to $999,999 | 1 | -- | -- | -- | 1 | 3 |
| $1 million to $4,999,999 | -- | 2 | -- | 2 | 1 | 5 |
| $5 million and greater | -- | -- | 6 | 2 | 1 | 2 |
| Total number of misstatements | 1 | 3 | 6 | 10 | 8 | 16 |
Corrected mistatements. Uncorrected statements.We issued a qualified audit opinion for our compliance audit of the Ministry of Health's Annual Prudential Compliance Statement
The Ministry of Health operates eight aged care facilities in NSW and is required to comply with the Fees and Payments Principles 2014 (No. 2) (the Principles) when entering into agreements with and managing payments to and from care recipients. The Principles are set by the Commonwealth Assistant Minister for Social Services. We identified 40 instances of material non-compliance in 2018–19, including:
- not agreeing maximum accommodation amounts payable with aged care recipients before they entered the residential care services
- not entering into accommodation agreements with care recipients within the specified period
- charging incorrect fees for activities or services to one care recipient
- not refunding two bond balances within the statutory framework
- not paying the correct amount of interest for 14 care recipients’ bonds refunded during the year.
Appropriate financial controls help ensure the efficient and effective use of resources and administration of agency policies. They are essential for quality and timely decision making.
This chapter outlines our observations and insights from our financial statement audits of agencies in the health cluster.
Section highlights
- The number of internal control deficiencies has increased since 2017–18. More than a quarter of control deficiencies are repeat issues and almost a quarter relate to information system controls. Both employee time recording and leave management remain as repeat issues in 2018–19.
- Control deficiencies that relate to managing employees' leave, employees’ time recording or information system limitations can be difficult for entities to resolve in a timely manner.
- Agreements for the treatment of New South Wales residents while they are interstate, and interstate residents while they are in New South Wales, are unsigned for Queensland, Victoria and the Australian Capital Territory for 2016–17, 2017–18 and 2018–19.
- NSW Health recorded $113.6 million in revenue from fees charged to Medicare ineligible patients during 2018–19 but has received payment for less than half of this.
- NSW Health reported that they completed three major capital projects during 2018–19.
- As at 30 June 2019 there were 30 ongoing major capital health projects in NSW. The revised capital budget for these projects in total was $2.2 billion more than the original budget of $8.0 billion.
- Health entities spent $635 million maintaining assets with a fair value of $19.8 billion of assets. Almost all entities were working through backlog maintenance during 2018–19, although several were unable to quantify the backlog.
- While entities are now regularly reassessing the useful lives of their assets, entities are still using a high volume of assets that are fully depreciated. Due to the age and nature of these assets the impact was not material.
Appendix one – List of 2019 recommendations
Appendix two – Status of 2018 recommendations
Appendix three – Financial data
Appendix four – Analysis of financial indicators
Appendix five – Analysis of performance against budget
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Volume Ten 2013 focusing on Health
Unqualified opinions were issued for all agencies audited in the following report.
Some of the reports findings include:
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Most cultural bodies rely heavily on government grants to fund services
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The Sydney Opera House Trust earns most of its revenue from commercial operations
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Less than half of the 2014-16 service agreements between HealthShare NSW and its customers have been signed. HealthShare NSW and health entities should finalise their 2014-2016 service agreements by no later than 31 January 2014
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Five service level agreements with NSW Health Pathology for 2012-13 were never signed. NSW Health Pathology and local health districts/speciality networks should finalise their 2013-14 service agreements by no later than 31 December 2013
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HealthShare NSW is committed to sharing internal audit findings across NSW Health
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The Ministry has started a long-term project to review its policy directives
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A recent review concluded the health sector has mature risk management practices
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When changes to the Aboriginal Land Rights Act 1983 occur, the Minister should identify and assess any risks from the changes and develop strategies to mitigate against them.
Volume Three 2013 focusing on New South Wales State Finances
The Total State Sector Accounts for the year ended 30 June 2013 received an unqualified independent auditor’s opinion. This is the first time in over a decade the Total State Sector Accounts have not been qualified.
In looking into the resolution of qualifications:
- We obtained enough evidence supporting the value of education buildings and their depreciation expense
- Sufficent evidence has been obtained to support the existence and value of the State archives
- We obtained enough evidence supporting the completeness of land and infrastructure holdings recognised
- Improvements are still needed in the accuracy of information used to record the State’s land holdings.
Volume One 2013 focusing on themes from 2012
This overview summarises the significant findings included in my 2012 financial audit report, volumes three to eleven, and highlights NSW agencies’ overall achievements and challenges. The overview summarises key themes and messages arising from these audits to help readers understand common findings. Agencies and their audit and risk committees can use the overview to self-assess and identify issues that may be relevant to their organisations.
It found more than 85 per cent of the recommendations in my 2011 financial audit reports to Parliament were implemented in 2012. Whilst this is less than 100 per cent, NSW government agencies clearly acted on my significant recommendations. However, NSW government agencies need to do more to follow up more detailed recommendations that are made directly to management.
Volume Nine 2011 focus on Education and Communities
The report includes comments on financial audits of government agencies in the Education and Communities sectors. The audits of the above entities’ financial statements for the year ended 30 June 2011 resulted in unmodified audit opinions within the Independent Auditor’s Reports. A key finding was that Treasury should consider issuing further guidance to arts and cultural bodies on collection valuation methodologies due to the significance of these assets to the State’s asset base.
Volume Three 2011
On 31 October 2011, the Auditor-General, Mr Peter Achterstraat, released Volume Three Report to Parliament on the 2010-11 NSW Total State Sector Accounts. The audited budget surplus was $1,340 million. The Auditor-General issued a qualified independent auditor’s opinion as the State could not identify the full extent and value of its land and infrastructure holdings for the eighth year in a row. The government needs to address its processes for identifying, valuing and recording land and related assets it controls as a matter of priority so it can effectively manage the full extent of its land and infrastructure holdings.
