Ontario's Health System: Audit Reveals a Troubling Accountability Gap

TORONTO, ON – December 10, 2025 – Ontario's public services have received their annual check-up, and the diagnosis is concerning. The latest follow-up report from the Auditor General of Ontario reveals a significant gap between identifying problems and implementing solutions, particularly within the last two years and in critical sectors like healthcare. While progress is visible over a longer five-year horizon, the slow pace of recent reforms raises urgent questions about government accountability and the tangible impact on the well-being of communities across the province.

Released today, the 2025 report tracks the government's progress on recommendations from past audits. The findings present a stark contrast: for audits conducted in 2020, 70% of recommendations have been fully implemented after five years. However, for the more recent 2023 audits, only 31% of recommendations are complete after two years, with a worrying 17% showing little to no progress at all. This isn't just a matter of bureaucratic bookkeeping; behind these percentages lie crowded emergency rooms, understaffed long-term care homes, and a growing deficit in public trust.

A Critical Diagnosis for Healthcare

Nowhere is the impact of this implementation lag felt more acutely than in healthcare. The two-year follow-up revisits the damning findings of the 2023 audits on Emergency Departments (EDs) and Long-Term Care (LTC), revealing that core issues persist. The promise to end “hallway medicine” remains unfulfilled; in fact, the problem has worsened. The original audit noted a staggering 203 unplanned ED closures between July 2022 and June 2023, primarily in rural and northern communities, driven by severe staffing shortages.

Two years later, the system remains heavily reliant on expensive, temporary nursing agencies to plug these gaps—a costly band-aid solution that undermines continuity of care. The Auditor General had previously found that the Ministry of Health was not even tracking the ballooning costs of this agency staff or the extent of staffing vacancies in ERs. This lack of a cohesive provincial strategy leaves individual hospitals to fend for themselves, resulting in prolonged patient wait times, which can exceed 24 hours for an inpatient bed, and forcing residents in some regions to travel significant distances for basic emergency and obstetrics care.

The situation is equally dire in long-term care. The 2023 audit highlighted that staffing shortages, with an estimated 8,000 open positions for nurses and Personal Support Workers (PSWs), made it impossible for many homes to meet provincially mandated direct care targets. This systemic failure was compounded by the controversial “More Beds, Better Care Act, 2022,” which allowed hospitals to place patients in LTC homes not of their choosing. The audit found at least 99 patients were moved without consent, yet the ministry was not tracking how many were subsequently charged for refusing a placement. Slow progress on these recommendations means that two years on, some of Ontario’s most vulnerable residents continue to face uncertainty and potential gaps in the quality and consistency of their care.

The System's Underlying Conditions

The Auditor General's report points to systemic issues that hinder meaningful reform across government. A recurring theme is the absence of comprehensive data collection and a cohesive provincial strategy. In both EDs and LTC, the ministries responsible have failed to adequately measure the problems they are tasked with solving. As one of the original 2023 audit reports was titled, What Gets Measured Gets Managed. Without tracking agency nurse spending, ED staffing vacancies, or the consequences of forced LTC placements, the government is flying blind, unable to craft effective, evidence-based policy.

This data deficit fosters a reactive, fragmented approach rather than a proactive, systemic one. Instead of investing in sustainable, long-term workforce solutions, the province has allowed a dependency on temporary fixes to fester. This not only inflates costs for taxpayers—with one hospital's agency spending jumping from $1 million to $8 million in just two years—but it also fails to build the resilient healthcare infrastructure that Ontario communities desperately need.

A Tale of Two Timelines: The Long Road to Reform

The report does contain a glimmer of hope, found in the five-year follow-up data from the 2020 audits. The 70% implementation rate suggests that with sustained pressure and time, significant change is possible. It underscores that complex public sector reforms are often a marathon, not a sprint. This long-term progress can be seen in areas audited five years ago, such as virtual care and blood management, where initial recommendations have now largely been addressed, leading to tangible improvements.

However, this positive trend is tempered by a crucial caveat: even after five years, 11% of the 2020 recommendations will not be implemented at all, and 4% still show little to no progress. This demonstrates that time alone is no guarantee of action. Some issues, it seems, are deemed too difficult, too costly, or too politically inconvenient to fix, leaving foundational problems unresolved indefinitely.

When Trust Is on the Line

Perhaps the most telling case study in the limits of accountability is the government’s response to the 2023 special report on changes to the Greenbelt. The audit concluded the process was biased, favoured certain developers who stand to gain over $8.3 billion, and lacked a sound evidentiary basis. It was a clear indictment of a failure in governance.

In response, the government accepted 14 of the 15 recommendations but pointedly rejected the most critical one: to re-evaluate the decision and the land removal process. This selective implementation sends a chilling message. It suggests that when an audit's findings conflict with the government's agenda, its core purpose can be dismissed. This erodes public trust not only in the government’s handling of environmental stewardship and urban planning but in its commitment to the principle of independent oversight itself.

This dynamic has profound implications for every sector, including healthcare. If clear, evidence-based recommendations for protecting public land can be set aside, communities are right to question the political will to tackle the equally complex and inconvenient truths found in our hospital corridors and long-term care homes. The Auditor General has once again provided a detailed roadmap for building a more efficient, equitable, and accountable public service. The health of Ontario’s communities now depends on the government’s willingness to follow it, especially when the path forward is difficult.