In the end, a feud between two civil servants over a promotion that dates back several years was the reason we found out that a provision of the Gesy law was completely disregarded by government and the political parties for six years.

By law, the sending of patients abroad for medical treatment they could not receive in Cyprus, at state expense, should have been the responsibility of the health Insurance Organisation (HIO), which is the paymaster of Gesy. Yet this law was never implemented, with the applications for treatment abroad being examined and approved by the health ministry’s permanent secretary.

This discretionary power given to the permanent secretary, who was accountable to nobody, suited the political establishment as its members could arrange for a member of their family or a supporter to be sent abroad for treatment with just a phone call. That most voiced their support for the existing arrangement, even after it was clear that it was in violation of the Gesy law, was because it had served them well.

The issue might never have come to light, had Health Minister Popi Kanari not held a grudge against the permanent secretary Christina Yiannaki, who was promoted to the post instead of her, when both were serving as senior civil servants at the ministry. The row entered the public domain after comments made on social media about Yiannaki’s qualifications were used by the minister to embarrass the perm sec and bring up the matter of sending of patients abroad.

Ironically the HIO, according to its chairman, is not able to undertake this responsibility at present and has asked for the organisation to be given time to prepare for it. It is difficult to know whether a bureaucratic organisation like the HIO would be able to deal with patients’ application efficiently, or whether lives would be put at risk by delays in the decision-making process. But the question of why the HIO, after six years, is not ready to take on a responsibility stipulated by the law, needs to be answered.

In theory, having all the power concentrated in the hands of one official ensures quick decision-making, but not necessarily rational, fair, and objective decision-making. The exercise of discretionary powers, combined with a lack of accountability, could give rise to corrupt practices. If, on the other hand, there are regulations and procedures in place for approving a request for treatment abroad, members of an organisation are more likely to follow them than an unaccountable civil servant. It is also more difficult for politicians to pressure an organisation that follows rules to do them favour.

Although the HIO does not always follow its own rules, giving it the responsibility for sending patients abroad is the correct move, as it would be less likely to approve applications, which are unjustified, as the money would come from its budget. Not to mention that the law, sensible or not, must be respected.