Select Committee on Public Accounts Minutes of Evidence


Examination of Witnesses (Questions 60 - 79)

MONDAY 9 FEBRUARY 1998

MR GEOFFREY RICHARD SCAIFE and SIR DAVID CARTER; MR JAMIE MORTIMER

  60.  To do a routine check of what section of the population?

   (Mr Scaife)  I believe the figures relate to the over 75s.

  61.  Over 75s? That seems almost incredible. If you do not feel absolutely firm with it you may want to come back.

   (Mr Scaife)  Chairman, is that something I can give you a note on?[1]

  Chairman:  That would be very helpful.

Mr Maclennan

  62.  Looking also at paragraph 2.41 on pockets of low treatment rates among local government districts, that suggests the possibility that social deprivation may be connected here. Has the Scottish Department ever given consideration to targeting those high risk groups who are suffering from social deprivation?

   (Mr Scaife)  Yes, Chairman. I explained that the Government has made tackling inequalities in health a strategic priority, and ministers have urged all health boards in Scotland to make sure in their planning they target in particular deprived communities.

  63.  I am interested in that but it does not quite answer the question. That is a very general targeting of a sector for everything, presumably these life-threatening illnesses as well. Has there been anything specific done about this particular matter of cataracts for socially deprived groups?

   (Mr Scaife)  Only to the extent, Chairman, the Report highlights this as a problem and the Report has been commended to the service.

  64.  What would the cost be here? Have you made any assessment of that? You say you have figures on targeting the over-75s, have you got figures on targeting the socially deprived?

   (Mr Scaife)  No, Chairman, we have not developed figures for targeting the socially deprived for cataracts.

  65.  Would you be resistant to doing so?

   (Mr Scaife)  Chairman, I would be keen to see whether we could do it.

  Chairman:  Another note I think[2].

Mr Maclennan

  66.  On the variation between practices and treatment rates, we are advised that-and I think this may be referring to general practitioners-so far as the surgeons are concerned if they do more operations generally they do more cataracts, as I understand the story. Is that a similar explanation of what happens in general practice, if they think about eyes they think about cataracts?

   (Mr Scaife)  Certainly the first point is right, that 80 to 85 per cent of a normal ophthalmic surgical workload would be cataracts. I do not think we have data which would tell us whether if general practitioners are thinking eyes they would be more likely to pick up cataracts than their colleagues; we simply do not have the data.

  67.  To what then is this extraordinary disparity in Figure 13, to which Mr Williams drew attention, to be attributed? A variation between 1:30 and 1:250 treatment rates.

   (Mr Scaife)  Chairman, I have already discussed the wide range of variables both in the community and which would apply when patients present at the hospital.

  68.  That variation seems pretty unacceptable. What is to be done about it? You have a wide range of variables, where do you put your money?

   (Mr Scaife)  Chairman, I think this is an area we would have to investigate in detail.

  69.  You have not got a thought?

   (Mr Scaife)  We are looking at all of our services across Scotland, all acute services. We are not looking at ophthalmology in particular but we could review it.

  70.  I know you could review it, but obviously this Report has raised these issues and you have not reviewed it, that is really what you are saying.

   (Mr Scaife)  We have not reviewed it at the Government level. What we have done is we have commended this Report and we commended the targets which underlie this Report to the health boards and to the trusts.

  71.  But you have not actually made any recommendations as to how to tackle these disparities. This is the problem. You have passed the buck, as I see it.

   (Mr Scaife)  Chairman, the job of assessing need, the job of deciding how to deploy resources on the ground is a job for the health board not the task of the Scottish Office itself. We have asked the health boards to look at the figures, we have commended the targets for day case surgery for cataracts to the health boards, and we will be pursuing with the health boards their attainment of the targets. I have already explained that health inequalities, including inequality or variability of accessing services, has been made a priority by the Government and we would expect to be able to pursue that with our health boards and to make sure they are getting behind the numbers, that they can explain the variable performance within their regions, and we would expect to pursue that and to pursue that vigorously.

  72.  Just a final, factual question you might be able to answer. What is the incidence of cataract in the over-65s?

   (Mr Scaife)  I have not got the figure here, Chairman.

   (Sir David Carter)  We do have it in a Scottish needs assessment programme. We have it here but my difficulty is concentrating on that particular group but we can get it for you[3].

  Mr Maclennan:  It is the age males retire, so it is not a bad starting point for people who are approaching retirement.

  Chairman:  Tell us before the end of the meeting.

Maria Eagle

  73.  If the target set out in 1992 had been reached, then this year you would be saving £1.47 million on the expenditure on these operations, would you not?

   (Mr Scaife)  Yes.

  74.  That would mean you would be able, if you could gee-up the GPs to refer a bit sooner and get some of the surgeons working a bit harder, to do more operations with the same amount of resources, does it not?

   (Mr Scaife)  It does.

  75.  So if you had succeeded in meeting these targets more of the people who were virtually blind, as we can see on page 33, whose vision is a little like that box at 6/60 with advanced cataracts, would be able to see a lot better than they can, would they not?

   (Mr Scaife)  They would, Chairman, if they were coming forward for treatment.

  76.  Yes. I find it surprising that you are not taking into account the fact a lot of people who go to their GPs are not referred soon enough. It seems to me there are plenty of people coming forward who are not being referred and I would have thought that would be a matter for you to be actively involved in, but all I have heard from you this afternoon, Mr Scaife, is, "We have commended the Report to the service, we have passed the Report on", you seem to be passing the buck.

   (Mr Scaife)  No, Chairman, I am seeking to point out the job of assessing need and deciding where to invest the cash is a job for the health board. They are much closer to their population, they are equipped to do that, in fact it is their job.

  77.  Who was responsible for making sure this target was met, this 80 per cent day case target? Who would you say has been responsible over the last five years for making sure that target was met?

   (Mr Scaife)  That responsibility would lie with the health boards, with the trusts and with the Management Executive.

  78.  What would your responsibility be in all this?

   (Mr Scaife)  My responsibility would be to make sure the service was aware of the targets, to satisfy myself that progress was being made and to ensure that there were not resource or other impediments to progress.

  79.  Right. Were you satisfied that progress was being made? As the Chairman pointed out at an early stage in the hearing, progress has been very slow from the start. He referred to Page 15, Figure 6 which showed right from the start progress has been slow. Were you satisfied with progress from the start? Do not tell me again you started from a low base-I know that and you knew that when the target was set. What were you doing to actually meet the target?

   (Mr Scaife)  Chairman, when the target was set Scotland was achieving 0.4 per cent of its cataract operations on a day case basis--


1   Note: See Evidence, Appendix 1, page 17 (PAC 195). Back

2   Note: See Evidence, Appendix 1, page 17 (PAC 195). Back

3   Note: See Evidence, Appendix 1, page 17 (PAC 195). Back


 
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