APPENDIX 1
SUPPLEMENTARY MEMORANDUM FROM THE SCOTTISH OFFICE,
DEPARTMENT OF HEALTH (PAC 97-98/195)
Cataract Surgery in Scotland
Question 59-61 and 64-65—cost of targeting over 75s and
those suffering from social deprivation
I regret that the figure I quoted for the cost of including
searching for cataract in the routine test given to over 75s was
wrong. The £20 million figure I quoted approximates to the
cost of introducing free eye tests for the whole population. The
direct cost of including testing for cataract in the routine test
for over 75s would be small, being the extra time in the GP's
surgery required to carry out the test. However, to include this
new requirement would require a UK-wide re-negotiation of the
standard general practitioners' contract. It is most unlikely
that such a re-negotiation would be restricted to the matter of
testing for cataract. The wider effect on resources of seeking
to impose such a change could therefore be very substantial.
As I said in response to Question 64, we have not developed figures
for targeting the socially deprived for cataracts. As for the
over 75s, any additional costs would be unquantifiable. They would
depend on how the targeting was pursued. Options could range from
mounting locally targeted publicity campaigns about the benefits
that cataract surgery might offer (which would have a limited
costs) to establishing specific outreach teams to visit areas
of social deprivation to try to identify where the need rests
(which would have a substantial cost). The balance between these
different approaches would depend on local circumstances—the
distribution of people who are socially deprived and the population
concentrations. I expect Health Boards to consider these options
in the light of the needs assessments that they carry out locally.
Question 72—Incidence of cataract in the over 65s
The information in the Scottish Needs Assessment Programme
on prevalence is based on the estimated prevalence of cases of
cataract in the Framingham eye study, and suggests that the Scottish
population in mid-year 1990 in the age group 68-72 was 217,422
with a prevalence ratio for cataract of 10.48 per cent giving
an estimated number of cataracts of 22,786. As the Chief Medical
Officer mentioned in response to Question 89, the incidence of
cataract is not necessarily the same as prevalence. Prevalence
is a measure of how much cataract there is in the community at
any given time, while incidence is the number of new cases that
will come forward each year.
Question 83—Day case surgery rate at Borders General
Hospital
On a comparable basis, the proportion of cataract surgery
carried out on a day case basis at Borders General Hospital increased
from 0.2 per cent in 1992-93 to 13.4 per cent in 1996-97. Provisional
figures show a rate of 57.4 per cent at December 1997.
Chairman's closing remarks—Achieving the Target
As reported in my evidence to the Committee, if current trends
continue, there would be an expectation that 80 per cent of cataract
surgery in Scotland would be carried out on a day case basis in
the year 2000-2001.
However, steps which have already been taken will facilitate
increasing the percentage carried out on a day case basis. For
example the proposed guidelines from the Royal College of Ophthalmologists
and the Scottish Intercollegiate Guidelines Network will make
clear the clinical case for carrying out cataract surgery on a
day basis. Furthermore, through the performance management of
the NHS in Scotland, I shall be ensuring that Health Boards and
NHS Trusts take steps to improve their rate of day case surgery
for cataracts where there is scope to do so.
These initiatives, together with the added pressure from
the publication of the NAO report and the Committee's deliberations
should lead to faster progress.
I am to discuss with the Minister the implications of seeking
to achieve a faster rate of progress.
The Scottish Office
Department of Health
20 February 1998
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