Examination of Witnesses (Questions 140
- 143)
MONDAY 9 FEBRUARY 1998
MR GEOFFREY
RICHARD SCAIFE
and SIR DAVID
CARTER; MR
JAMIE MORTIMER
140. Okay. Can I turn to Figure 9 on Page
18 because I wanted to pick something up here about this. I have
listened to your explanations on this. Do I take it basically
that since these statistics are not comparing like with like they
are useless for our purpose and for the purpose of this Report?
When you were explaining why lessons could not be drawn from them
in the way that some of my colleagues were drawing lessons from
them, you seemed to be giving us a position where you should have
had so many footnotes as to almost explain them away. In the circumstances,
given you accepted these statistics, I am a trifle confused as
to why you let that go.
(Mr Scaife) Chairman, I have already
explained the particular circumstance of the West Glasgow University
Trust which is a major teaching and research centre and where
eye cancer and other very highly specialist --
141. I know all that. Given all that, surely
that means that having these two sets of statistics here to compare
one with the other to make a particular point is actually useless
and that ought to have been drawn to the attention of the authors
of the Report at an earlier stage so that we would not be led
into drawing a lot of the conclusions that really cannot be drawn
from it?
(Mr Scaife) I think it is reasonable
to point to the variability and suggest, as the footnote does,
the point that one has to take into account the relative willingness
of the surgeon to carry out day surgery. All I was seeking to
point out was that you cannot compare directly the pattern for
the Dundee hospital with West Glasgow.
142. One final point-the Chairman has indicated
my time is almost up and you have been stalling manfully throughout
my contribution, as indeed throughout many of the others-could
I ask you a question about social class and fair allocation. There
has been identification that possibly 24,000 people per annum
would be coming forward and you have explained to us how you are
meeting expressed demand. Would it be your view that were an exercise
mounted to try and deal with this that in fact many more would
be discovered? You seemed to be adopting a position earlier on
that it is the patient's own fault for not presenting sooner.
That is a view not all of us share. Is there a hidden iceberg
out there of people that will require this operation that will
come to light at some point in the future?
(Mr Scaife) Chairman, I have sought
to explain that there is not a growing number of patients sitting
on waiting lists waiting for cataract surgery.
143. I know that.
(Mr Scaife) The demand is being
met. I have also sought to explain that the 24,000 figure relates
to estimated prevalence in the community. There is then the assessment
undertaken by the clinician as to whether the patient requires
an operation. There is a discussion with the patient about whether
the patient wants an operation. That discussion is partly about
the patient and the patient's lifestyle and what the patient wants.
There is a difference between estimates of how many cataracts
there are out there and the number of cataracts that end up being
removed. We are talking about two different things, the estimate
of prevalence and the decision at the end of the day, partly taken
by the patient, partly taken by the consultant as to whether the
cataract should be removed or not.
Chairman: Mr Scaife, Sir David, perhaps
it would be helpful if I reiterate the purpose of this Committee.
The Committee of Public Accounts under the 1983 Act was set up
to review the delivery of Government policy, its economy, its
efficiency, its effectiveness and we are interested in all of
those things. You are before us because you are the accounting
officer. In 1996-97, according to the numbers we have seen, Scotland's
achievement of this target was 36 per cent. England's achievement
of the same target was 59 per cent, presumably under the same
regime as you operate. You have accepted today that the 80 per
cent rate is achievable and you have argued about the time but
what concerns this Committee is the speed at which you are achieving
this rate. From what you have said, it seems to devolve almost
entirely on the willingness of surgeons to do day case surgery
irrespective of your target set. Frankly, it is my view, and I
think it is the view of the rest of the Committee, that is a matter
for you to sort out, but the fact that the Borders General Trust
increased day surgery from 13 to 90 per cent in six months flat,
and not five years, indicates what is possible. The fact Moray
Health Trust has a zero score indicates what is actually happening
on the ground. You have spoken about clinical judgment and I think
we all understand this matters in individual cases, of course
it does, that is why it is an 80 per cent target and not a 100
per cent target. Clinical judgment should not, as Mr Davidson
said, supersede best practice overall, that is not the purpose
of it. Raising the rate of day surgery to 80 per cent will either
increase the numbers treated and speed up queues or, if that is
not necessary, it will save well over £1 million. Again you
accept that message. I am sure you can find a use for £1
million in the Scottish Health Service. If not, we have the Treasury
here listening carefully to the other options. What I would like
to hear from you, or see from you in a note to be provided, is
a plan showing some explicit actions, some individual targets
and some timetables for the achievement of those targets[5].
Frankly, if you come back and say 2001, we will not be very happy.
If you are handicapped by your powers or policy limits-and that
may be possible, I do not know, I cannot tell listening to you
today-this Committee would like to know that. Frankly, if that
is the case I would strongly recommend you raise the matter with
your minister. We do not have an interest in recommending policy
changes here, that is not our business, but frankly if this cannot
be achieved under the current policy then we may well, very unusually,
be summoning your minister to explain. You will gather I have
not found this a very satisfactory meeting. Thank you very much
for coming.
5 Note: See Evidence, Appendix 1, page 17 (PAC 195). Back
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