The Audit Service is working to clarify the circumstances that led to the mishandling of the state health plan for referring patients to specialist facilities abroad, spokeswoman Yiota Michael said on Wednesday.

Elsewhere, former health minister and lawyer George Pamboridis told Politis radio that such patient referrals had been deliberately assigned to higher ministry officials while they had been previously handled in a merely bureaucratic manner.

Last Friday, reports emerged that the Health Insurance Organisation (HIO) had planned to hire permanent health secretary Christina Yiannaki immediately after her retirement to oversee the patient referral programme, which had been delayed beyond its initial implementation date.

According to the HIO, Yiannaki and another official – also slated for retirement in September and considered for hire – were the only individuals qualified to manage the programme.

Pamboridis, however, argued that the management of the referral service was not in fact a difficult task, and that time was sufficient to effect its takeover by the HIO. In contrast to what ministry officials and others had claimed, no extensive transition period was warranted, he said.

The job had been moved to the executive levels of the health ministry purely so that it could be used as a tool for political gain, he said.

“It’s the ideal weapon for favouritism, exploiting people’s [medical] needs for gain. It became a means of providing by dropper [what] the system ought to be providing to every citizen in need,” Pamboridis said.

“People have built entire careers on doing this job when they should have been working [as clerks] at citizen service centres,” he charged.

Despite this, Pamboridis said, since the introduction of the state health care system (Gesy) such abuses had been rectified, in their majority.

The ex-minister suggested that the general directorship and the health minister ought to be probed as to their responsibilities over the matter. The HIO needs to simply send Yiannaki on her way and pay seconded health ministry staff to complete the task, he said.

The HIO was in no position to demand staff from the ministry and those who had benefitted from the system of favouritism were merely clinging to their privilege, the ex-minister said,

“These are remnants of the old state which Gesy was supposed to do away with.”

Meanwhile on Tuesday the Audit Service had sent a letter to the head of the HIO, with a copy to the health ministry, seeking clarification on how the organisation and the ministry ended up in this state of unpreparedness, Michael told CyBC.

The referral of patients abroad falls under Article 33 of the state health system law, which empowers the HIO to set criteria for patient referrals, establish eligibility procedures and determine compensation.

The programme was originally set to take effect in January, with the HIO assuming full responsibility. Given that Yiannaki was due to retire in April, a three-month transition period had been planned to allow her to assist in her role as health ministry director if necessary, the Audit Service said.

Beyond concerns about patient safety due to the delay, the Audit Service is also examining the financial impact of hiring Yiannaki as an external contractor, which would place an additional burden on the state budget.

There are also concerns about setting a precedent where a single individual is deemed indispensable to a state service, limiting future options.

The HIO attributed the situation to understaffing, arguing that Yiannaki and her associate were “the only available professionals with many years of experience and specialisation in administering the procedure of sending patients abroad, and as such, their expertise was necessary.”

In addition to investigating the reasons for the extended timeline, the audit service has asked whether the HIO intends to directly contract Yiannaki, why it remains underprepared, and what progress has been made on the programme so far.

It is also requesting details on when the implementation date was moved and whether the health ministry had been informed and in agreement.