All the measures put in place to bolster staffing in public hospitals mainly concerned pay rises and in essence satisfied the demands of doctors and nurses and did nothing to improve state health provision, an audit of the health ministry has found.
According to the report following the ministry’s annual audit, these measures do not contribute to the improvement of the state facilities’ functionality. The audit service said that by now, the ministry ought to have taken all necessary measures to reorganize public medical facilities.
“It has been determined that while various expert studies have been carried out, none have been utilized to date,” the report said.
The most recent one, dated May 2017, concerned human resource management in public hospitals and included all the important findings of previous studies which highlighted serious longstanding problems relating to staff organisation, low productivity, distortions in the working hours of doctors and nurses and so on.
The auditor also struck a note of caution over the timeframe of implementation of the national health scheme, noting that certain projects have been delayed.
“Execution of important projects that are necessary for the implementation of the Gesy like reorganization/autonomy of state hospitals, which should have been handled as a matter of priority have been greatly delayed,” the report said. “Instead, our service noticed that priority was given – mainly by the health insurance organisation – to projects that are mainly of procedural nature that necessitated the recruitment of consultants at a cost of many millions.”
The report also highlights irregularities in overtime pay and the use of staff as drivers by the permanent secretary.
The service note that two ministry employees did not have fixed work hours and in some cases, they worked until midnight without interruption.
The ministry permanent secretary said overtime work in the cases in question concerned driving her to various events where she represented the minister.
“It is the view of our service that the Republic does not afford driving services to any civil servants or state officials,” the audit service said, but if the staffers’ working hours must be extended before the normal timetable, then time off must be given in lieu and not overtime pay.
Also, the report said, the health ministry still has no criteria in place concerning the selection of overseas centres where patients from Cyprus are transferred for treatments not available on the island resulting in waste of taxpayer money.
“We repeat our recommendation for the health ministry to set up a unit that will deal with finding medical centres, as well as their evaluation according to specialisation so that patients sent there undergo medical treatment at medical centres with the highest success rate as regards rehabilitation,” the report said.
The audit service said it expected that by now the ministry would have already had evaluated the quality of services it procured from overseas centres with the criteria being successful surgeries, possible complications, and mortality rates.
The ministry said that it had drafted a list with suitable specialised medical centres for various conditions, that have agreements with the respective countries’ national health schemes.
The permanent secretary responded that setting up a unit to find specialised centres was something the ministry agreed with but doing so would necessitate human resources that were currently unavailable due to personnel shortages.
The head of the ministry also said that in May this year officials had visited centres in Germany where Cypriot patients were referred to and more similar visits were on the cards in other countries.
According to the report, despite European citizens having the right of medical treatment in other member states, with the bill picked up by their government at a price defined by the national health scheme of the member state in question, Cyprus continued to send people abroad as private patients at a higher cost.
Treatment as private patients carries higher charges for procedures as well as hospitalisation.
In a letter to the permanent secretary, the committee of paediatric specialists said charges in cases of children’s gastro at a certain hospital in London were excessive.
In one case, the cost for an endoscopy plus two days in hospital was €8,395. A four-day extension of the stay and intravenous antibiotics cost an additional €5,578.
The audit service also highlighted serious lapses in procedures relating to the referral of patients to overseas centres.
In 2016 the ministry had sent patients to various EU countries, Israel, Lebanon, Switzerland, and the USA.
The audit focuses on the UK, Germany, Greece, and Israel, where most patients had been sent, and found “serious omissions mainly as regards the way of referral – privately and not through the national health scheme – the absence of agreements, and the lack of satisfactory checks before payment was made.”
According to the records, in 2016 Cyprus dispatched 276 patients to Germany – 247 through the NHS and 23 privately. No reference was found for six cases.
Cyprus paid Germany some €4.8m for treatments between 2013 and 2015 while the island’s embassy paid an additional €403,578.
A sample audit of the payments slips sent by the embassy to the ministry found that they were in the German language, making them impossible to check and that certain payments were not covered by the NHS because they were made through the embassy.
Despite the ministry approving the payments, there is no explanation of what they concerned and why they were not covered by the NHS. Payments to patients were also approved without subsequent verification.
The audit also found out that while sending patients through the respective NHS to Germany, France, and the UK, the ministry does not do so for Greece.
In 2016, 426 patients were sent to Greece and Cyprus paid some €3m directly to medical centres and €170,196 through the embassy.
The audit found failure to verify that the charges corresponded to the consolidated prices (payment scheme in Greek hospitals) that the ministry said it was paying. Nor was any evidence found by auditors that the patient had been charged bases on the scheme.
Payments were also made without an invoice. Instead, the ministry was given a receipt and a letter from the doctor who certified that it had been issued against an invoice.
Similar findings were reported when it came to Israel.
The permanent secretary said agreements could not be made with specific hospitals since incidents differed from patient to patient. In such cases officials got quick bids and opted for the lower one.
“All the cases sent abroad are complex and there is no expertise in Cyprus to tackle them,” the ministry said. “Any binding agreement with a specific centre for specific health services would eliminate the ministry’s ability to send patients to specialised centres depending on each case.”