Examination of Witnesses (Questions 40
- 59)
MONDAY 9 FEBRUARY 1998
MR GEOFFREY
RICHARD SCAIFE
and SIR DAVID
CARTER; MR
JAMIE MORTIMER
40. But given those patients are mostly
elderly, almost all I would suspect, and they may well therefore
have suffered a long-term deterioration in their eyesight before
they reached the point where they sought treatment, and we do
not know at what point that is, that three months is not just
three months of having problems with their eyes, it represents
a much longer period than that for that person?
(Mr Scaife) Yes, it could.
41. Does that mean that you are considering
what measures you might take in the future to help address that,
to help people basically to see for as long as possible?
(Mr Scaife) I would fully expect
that precisely this question would be encapsulated by the Royal
Colleges in the detailed guidelines they will be producing. They
would be recommending, if you like, thresholds of visual impairment
for referral. They would be recommending thresholds of visual
impairment for the operations to be carried out. I would fully
expect them to be addressing the question of how long it is reasonable
to expect patients to wait.
Mr Maclennan
42. May I follow up this question of waiting
times. I was not clear about your answer to the question how long
is specified by Ministers. You gave an answer that seemed unrelated
to the question.
(Mr Scaife) Ministers have specified
that patients must be treated within 12 months and in fact we
have a guarantee in Scotland that no one should wait more than
12 months for treatment of cataracts.
43. So the waiting times you referred to,
the 12 months is following the diagnosis?
(Mr Scaife) Correct.
44. Do we have any knowledge of what the
waiting times are to reach diagnosis?
(Mr Scaife) Can the CMO answer?
(Sir David Carter) I think it is very difficult
to answer that question because a number of people will have cataracts
but will not have significant impairment of visual acuity that
interferes, in their view, with their quality of life. You have
got to qualify the presence of cataracts with its effect on visual
acuity.
45. Reverting to the issue of the variations
in treatment I think, Mr Scaife, you said that it was unfortunate
that patients present so late in answer to some questions from
my colleague, Mr Williams. That rather suggests that the norm
in your mind is that someone should come forward with a complaint
to be diagnosed. Is that correct?
(Mr Scaife) I was suggesting that
ideally people would approach their optician or approach their
general practitioner early in the development of a cataract and
I expressed regret that some patients do come forward so very
late.
46. How would patients who might benefit
by cataract treatment know that it would be appropriate for them
to come forward? Would it be as a result of deterioration of their
eyesight or what?
(Mr Scaife) It would usually be
because they were having trouble in bright sunlight or their eyesight
was deteriorating.
47. Is it your general view and the advice
of the Department that people who are experiencing such deterioration
or difficulty should come forward? How do you go about disseminating
that view?
(Mr Scaife) Again, we have not issued
specific advice or mounted specific campaigns nationally to try
to raise awareness about cataracts as such but we have a very
active health education/health promotion programme in Scotland.
48. Is it targeted towards the elderly in
respect of cataracts?
(Mr Scaife) It is certainly targeted
towards the elderly but not at cataracts as such.
49. Does it have any impact at all?
(Mr Scaife) We believe it has impact
in relation to services for drug misusers. It has considerable
impact in relation to coronary heart disease and cancer by putting
out messages about healthy living and about coming forward for
treatment.
50. But it does not really do much about
cataracts?
(Mr Scaife) Cataracts have not been
singled out as a particular priority whereas coronary heart disease
and cancer and mental health have, since these are the major killers
and the major disablers in Scottish society.
51. It is a rather simple matter to deal
with if it is identified and diagnosed?
(Mr Scaife) Yes it is, Chairman.
52. Failure can cause very considerable
disability and deterioration in quality of life?
(Mr Scaife) Yes it can. I fully
accept that and clearly the public--
53. The point is, is the policy that is
being pursued in respect to health education only being directed
effectively at killers?
(Mr Scaife) No, Chairman, we have
a range of priorities. Cancer, coronary heart disease, mental
health have been our three priorities for the last two or three
years. Mental health, of course, is not a major killer but is
certainly a major disabler and has a huge social impact as well.
54. I have to say that the overriding impression
that is given by the figures and the tables which we have had
here today and which we have been looking at is one of remarkable
variation and one asks how this has come about and it is evident
it is because there has been no policy effectively to tackle these
variations. Is that fair comment?
(Mr Scaife) Chairman, there has
been a policy to increase the level of cataract surgery done on
a day case basis just as there has been a policy to increase the
proportion of all surgery done on a day case basis. Cataract surgery,
of course, is a relatively small part of the whole.
55. That is what we happen to be talking
about today.
(Mr Scaife) Of course, I understand
that.
56. Cataract rates, we learn from paragraph
2.44, depend chiefly on whether the general practitioners actively
search for cataracts or respond to patient demand. Is there anything
to be said against the proposition that general practitioners
should actively search for cataracts with certain at risk groups,
notably the elderly?
(Mr Scaife) I think there is no
argument to the suggestion that if we are to get at the patients
who are not coming forward and pursuing actively the need for
treatment then we would have to rely on general education campaigns
and that would include general practitioners seeking out more
actively.
57. Could that be summarised by saying that
you would favour general practitioners actively searching for
cataracts amongst at risk groups?
(Mr Scaife) I would favour general
practitioners actively seeking out cataracts from at risk groups,
but if you were to ask the range of general practitioners to do
that then we would have to think about the resource consequences
of doing that and we would have to think about what else we might
be foregoing. So one would have to consider it in the round and
that obviously would be a policy decision.
58. Have you made no estimates of what the
consequences would be in resource terms of such routine checks?
They are not very difficult to do nor do they take a great deal
of time.
(Mr Scaife) We have made estimates
and it would be a good many millions of pounds in order to do
that.
59. A good many millions? How many millions,
can you say, if you have got it to that degree of particularity?
(Mr Scaife) The figure I have is
just under £20 million.
| 
