News

The Department of Health's guidance on the identification, referral and registration of sight loss suggests that the system will "improve the speed of referral for social care" and "improve the accessibility and understanding of the process for patients".

The review of registration was in response to lobbying by user groups and professional bodies who believe it takes too long - often more than a year - from detecting sight loss to receiving an assessment and rehabilitation services.

It has also long been recognised that the rate of certification and registration among people who would be eligible is low (estimates vary between 25 per cent and 40 per cent). Months or even years can pass while people go through primary and secondary eye care services before social care and rehabilitation services are offered. During this time, vital independence and confidence can be lost. A quicker pathway to social care is needed.

One reason this has not happened is that ophthalmologists have not always referred people for a social care assessment at the earliest opportunity, but have waited until medical intervention has been exhausted.

New evidence in a report by The Royal National Institute of the Blind shows that even people who have been certified by the ophthalmologist and registered with local authorities as blind or partially sighted have not received any statutory care services or rehabilitation.

The report, Unseen, explores the quality of life of 588 blind and partially sighted people, 83 per cent of whom are already registered. It found that only just over half had ever received a home assessment and that the majority had not received vital pieces of equipment that could have helped them live independently, such as white canes, task lamps for reading and close work and talking kitchen appliances. So in what sense is registration a passport to better care or greater independence?

Registration is not an automatic route to services under the new eligibility criteria for social care, known as Fasc - Fair Access to Social Care. There is huge concern among user groups that, in the absence of strong, central guidance, the response of many councils to Fasc might be to put them into the lower categories of eligibility. This is despite strong evidence of mobility problems, difficulties in cooking, cleaning and self-care and a vastly increased risk of falls and accidents.

Many useful and cost-effective products have been designed to help people with sight loss undertake everyday tasks safely and prevent premature dependence. Yet despite this, they are still not universally offered with appropriate training by local authorities. Unseen found that only 41 per cent of people had been offered a white cane and only 37 per cent had been offered a liquid level indicator which can help prevent scalding when preparing hot drinks. Those who had been offered such items found them useful.

This equipment gap ought to be narrowing. After an Audit Commission report identifying the confused state of local authority equipment provision,¹ the government issued guidance that all health service and social services equipment stores should look to merge by 2005. To facilitate this it added an extra £220m to the NHS budget. The experience of local user groups indicates that there appears to be little clinical or strategic level of understanding within primary care trusts of the need for sensory impairment equipment.

Community equipment was intended to be provided free from last April. Yet charities, including the RNIB, continue to receive requests from councils for charitable donations. If this request is declined, it is sometimes suggested that the equipment will not be provided, despite assessments confirming need. This situation causes unnecessary suffering for blind and partially sighted people.

There are many reasons for the dearth in services. Serial under-reporting of partial sight has led to misleading registration figures and the erroneous assumption among care service planners that sight loss is a low-incidence disability, even though one in 12 people older than 60 will lose their sight. It has also long been known that many blind people have other disabilities that can jeopardise their chance of retaining independence and mask the effect of their sight loss.


Services for people who have lost their sight are lacking and do not reach most people who need help. Awareness of these services among those who would benefit most from them is poor and many people are surviving hand-to-mouth outside a system that is supposed to support them. New streamlined signposting to social care is to be welcomed, but is there enough capacity to deal with unmet need?

Facts about blindness and sight loss

People who could register as blind or partially sighted - 1.1 million

People who are registered - 350, 000

Percentage who live in or on the margins of poverty - 73%*

Who live alone - 62%*

Who have daily contact with someone they trust - 36%*

Who have ever received a home assessment - 53%*

Who have ever heard of mobility training  - 30%*

Who have ever heard of social services rehabilitation - 41%*

Number of rehabilitation officers working in the UK - 600 to 800

* Source: Unseen report 

Dan Vale is the UK campaigns manager at RNIB and author of Unseen: Neglect, Isolation and Household Poverty amongst Older People with Sight Loss. Available from 0845 702 3153.

Reference

¹ Audit Commission, Fully Equipped, 2000. Go to http://www.audit-commission.gov.uk

Website

DoH guidance from www.doh.gov.uk/sensoryimpairment

Campaign coalition

The Improving Lives coalition of 15 organisations was set up to draw attention to the lack of resources and national standards of care for blind and partially sighted people. 

It feels that the system of health and social care is allowing this group of people to slip into ill-health and premature dependency. 

Chairperson John Wood says: "Across the country there are huge variations in the availability, quality and timeliness of care and in the charges applied by local authorities for care services. This has led to large disparities in the quality of life for blind and partially sighted people from one area to the next."  http://www.improvinglives.co.uk

A lonely life   

Gerard Oskievecz, 81, lives alone in Nottingham and has no family. He has age-related macular degeneration and was certified and registered blind in 1988. Two months later, a social worker visited him but offered no practical help. On a second visit soon afterwards, Oskievecz was introduced to Nottingham Royal Society for the Blind. That was the extent of statutory support. No further help or information from social services followed, no practical products, benefits advice and no offer of mobility training or NHS exceptions. Oskievecz was living on less than £29 a week after he had paid all his bills and had been living on a diet of cheap soup he prepared himself. The only help he has received in more than 15 years has been from the local RSB branch which told him about monocular magnifiers - and these have greatly improved his quality of life.