From 2003-11, the number of people registered blind by council social services in England fell by 5.6% while the number of people registered as partially sighted fell by 2.6%. The number of new blind registrations per year fell by 30% and new partially sighted registrations fell by 28% over this time, though rates varied significantly between and within regions.
Recently published RNIB research studied the process of certifying and registering people as sight impaired to understand why registration numbers have been falling.
Certificates of visual impairment (CVI) are completed by consultant opthamologists following assessment of whether people are sight impaired or severely sight impaired. These are then passed on to council social services departments to decide, following assessment, whether people should be registered as blind or partially sighted, to help them access services and assist councils in planning for services.
The RNIB report interviewed service users and social care and hospital professionals in three urban areas in England and found the certification and registration process varies widely.
Cetification and registration
There are five stages of the certification and registration processes:
- Deciding it’s right to certify.
- Completing the certificate of visual impairment (CVI).
- Sending the CVI to social services departments.
- Initial assessment by the social services department for registration
- Follow-up assessment for registration.
Each professional involved in the process – consultant ophthalmologists, registrars, optometrists, medical secretaries, certificate of visual impairment administrators, eye clinic liaison officers, rehabilitation managers, social services managers and administrators – has the potential to create barriers and delays or to improve the processes.
Barriers in hospital
Guidance from the Department of Health and Association of Directors of Adult Social Services states it should take 15 days from issuing a certification to completing registration. A small number of service users stated they completed the certification and registration process in 15 days but, for most, access to support took much longer. The main barriers happen in the hospital and concern:
- Deciding when to certify patients, particularly those with long-term conditions such as age-related macular degeneration and glaucoma;
- The length of time for consultants to complete CVIs;
- The length of time to send CVIs to social services;
- Sending incomplete CVIs to social services.
One reason why these barriers occur is that many ophthalmologists are poorly informed about the benefits of being certified and registered and are unable to advise patients. Not knowing the purpose of certification and registration can influence who is offered certification and when. For example, some consultants said they did not certify older people as they already received services (such as free television license). The RNIB is working with partners to improve information available to ophthalmologists, but this can also been done at a local level.
Developing a good relationship with hospitals
By building a relationship with the local ophthalmology department, social services staff can improve the process. In Bradford, the adult and community social services team and the teaching hospital have met since 2006. Consultant Peter Atkinson said the social services team are invited to the hospital ‘when there is a topic of special relevance’ and typically provide information on the services they provide.
Simon Labbett, rehabilitation officer for visually impaired people at Bradford council, said: “From the beginning the hospital was responsive and recognised patient care was area that needed to be well maintained.” In addition, one consultant regularly attends the low-vision services meeting.
The relationship between hospital and social care is further strengthened by the eye clinic liaison officer (ECLO), who attends all clinical meetings and shares information about what the social services department offers. All interviewees said ECLOs, whose role is to help people with sight loss access the support they need, improved the certification and registration process.
Are fees a factor?
Many social services professionals said certification and registration has dropped as the CVI fee structure has changed making consultants less inclined to certify patients. While an estimated 60% of opthamologists are on contracts that involve a payment for certification, those employed on contracts from 2003 are typically not.
However, in two of the three areas studied many consultants (but not all) donated their certification fees to fund the ECLO or to a local vision charity.
Social services changing lives
The practical assistance offered by social services staff was highly valued by service users. One described how the rehabilitation worker changed their life: “I faced my fear thinking I’d never walk in the dark anymore and thanks to [the worker], they’ve trained me to walk in the dark.”
When the certification and registration process works well, service users are able to access support quickly and report that it changes their lives. Improving consultants’ awareness of what social services offers and the benefits of being registered can help to improve who and when service users are offered certification.