Auditor-general asked to revoke Western Cape Health's clean audit

Last year Auditor-General Kimi Makwetu gave the Western Cape Health Department (WCHD) a clean audit. At best he was generous, at worse, mistaken, particularly regarding them allegedly meeting their performance objectives.

In my opinion he made a mistake signing off on their 2018/2019 annual report containing their congratulatory self-assessment of all performance objectives when the facts say otherwise. 

The AG is preparing for the 2019/2020 annual audit of state departments. This week I wrote asking him to review his decision. He confirmed receipt. This is an edited version of my letter.

On November 21, 2019 I sent a report to the then head of health Dr Beth Engelbrecht (she was replaced by her deputy, Dr Keith Cloete from 1 April 2020), Premier Alan Winde and chair of the health committee of WC Legislature Wendy Philander my assessment as a patient of WCHD of its high-level financial position, cost efficiency and performance objectives in terms of patient care. 

Independent reports state the service is "failing the people it serves" (Treatment Action Campaign). Based on user perception, it scores 48%, the fourth lowest in the country (South African Health Review 2017), down from 53% in 2016.

My report mentioned other problems like the department’s poor labour resource utilisation and cost inefficiency.  And worryingly, in her October 2019 presentation, Engelbrecht falsely told the WC legislature and public (and me) the department's budget had declined over the past four years “in a row” and patient numbers drastically increased. It’s a mystery why she said so when their financial reports say otherwise, and why the executive and legislature believed her. I suggest the falsehood was grounds for you to review your findings. There was no response.

Another problem is AfriForum laid criminal charges against Engelbrecht in November because of irregular expenditure. 

I wonder if these problems are why she was quietly replaced when typically incumbents remain more than one five-year term in office.

In reaching his findings, Makwetu must not take WCHD's positive self-review of their performance objectives at face value. Instead, he should rely on objective criteria and independent reviews, either their own or credible sources like Health Systems Trust’s annual surveys (available free for download). 

Perhaps he's not aware there's at least a five year backlog of “unnatural causes” deaths cases at the Cape Town Inquest Magistrate Court, Groote Schuur Hospital alone contributing a significant portion (disclosure: my late mother's is one). In part, these inquest investigations refute the WCHD's self-congratulatory claims of its allegedly excellent performance and assertion in the 2018/2019 annual report under “organisational culture” that staffs have concern for “clients” (patients). 

I suggested he test WCHD’s self-review of its performance objective for patient complaint resolution (97%, 2018/2019) on the criteria whether complaints were resolved to patients’ satisfaction. As a rule WCHD dismisses all, or almost all, complaints of poor care even when they have merit, often aggressively so with no internal recourse. Therefore, according to them, but not patients, resolution is almost 100%.

The AG must review how transparent and accountable the complaints process is (in fact, not very).  Review how many cases were resolved to patients’ satisfaction at the WCHD’s Independent Health Complaints Committee the rare times they were referred there. Note the IHCC is not “independent” but exists and operates by the head of department’s favour. In 2017 by Engelbrecht’s fiat, it ceased functioning, abandoning complaints already on the roll. These were not rescheduled. All this contravened the enabling provincial legislation. These facts were not made public and no explanations given except for alleged “logistical reasons” or committee member resignations, one is not sure which. It’s unknown if it’s functioning again.

Also, review how many complaints against WCHD healthcare workers were referred to the Health Professions Council and other councils. (During the 2018/2019 financial year the HPCSA investigated our complaints against Engelbrecht, GSH CEO Dr Bhavna Patel and other GSH practitioners including a head of department. Related to this and an inquest case, in this present financial period, SAPS and Cape Town’s Director of Public Prosecutions received our criminal complaint under the Prevention and Combating of Corrupt Activities Act implicating Groote Schuur and Tygerberg hospitals heads of department.)

Review how many medical malpractice cases are being litigated. Note the WCHD views all malpractice litigation as “touting” irrespective of the merits.

The number of unnatural causes inquest cases opened at Woodstock police station alone concerning Groote Schuur proves there are problems with patient care and refutes their self-assessment of excellence. The clerk of the inquest courts in the Western Cape should give you a list of the number of new and existing cases for the audited period.

WCHD’s last annual report says some performance objectives cannot be measured – “it is not possible for the department to predict [sic] with accuracy” – but nevertheless gives themselves excellent marks for these sections, which you approved. On this basis they received a clean audit.

Auditing and accounting are not about “predicting”, which is astrology, but measurement and observation of the evidence. The AG must dismiss WCHD records and measurements where prediction is used and that cannot be verified to an audit certainty.

I suspect once he reviews all the evidence and apply the auditor’s dictum to be aware of fraud and error at all times, the WCHD might not be worthy of a clean audit for 2019/2020.  (Disclosure: I was a contract auditor for the AG in 2005 to 2007.)

I sent a copy of my letter to the head of WC health Keith Cloete and Premier Alan Winde. Cloete acknowledged receipt.

In other news, the Western Cape Government is celebrating the Cape Town High Court setting aside the auditor-general's qualified audit opinion of the Department of Agriculture's 2016/17 and 2017/18 financial statements. The WCG contested the 2017/18 qualified audit opinion only. It concerned the AG's interpretation of transfer payments. Winde said the judgement provided clarity for all government departments conducting transfer payments.