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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