Defining Vision

The government’s adult social care green paper sets out the case
for a radical rethink of service delivery. Its focus on outcomes
and empowerment signals a shift from measuring what is provided to
evaluating the benefits to service users. It also emphasises the
importance of preventive work and calls for strong links with the
voluntary and community sectors to encourage local
capacity-building.

These sectors have traditionally been seen as the main providers of
social care for people with a visual impairment. One such
organisation is Thomas Pocklington Trust, a specialist provider of
housing and support for people with sight loss in England. The
trust is managed by a board with service user representation and
runs sheltered housing, residential, day, home care and
community-based services.

Anticipating this new agenda, the trust commissioned the University
of Birmingham to evaluate its day services for people with a visual
impairment in the West Midlands. The aim was to identify a holistic
understanding of users’ needs and outcomes and how these might be
best met. The core of this was users’ own definitions and so the
research began with focus groups to explore their experience of
visual impairment at home and in the community. For example, one
service user spoke about the pain and loss that he experienced when
friends no longer greeted him after he became visually impaired.
Another spoke of his annoyance that his relatives found it
difficult to let him do things for himself. Others talked about how
they had worked out ways of establishing what was where in their
freezer or the colour of clothes in their wardrobe.

Based on these discussions and academic and inspection
literature,(1),(2),(3) we created a schedule of seven areas of
potential need. These were: meeting people and friendship; getting
information and advice about other services for people with a
visual impairment; finding out about special equipment; having
someone to talk to about your personal feelings; building your
confidence to go out and do things outside your home; re-learning
how to carry out everyday tasks in your home; and getting help with
practical everyday tasks.

There are parallels between this list and the government’s outcomes
which emphasise “access to leisure, social activities and life-long
learning, and confidence in safety outside the home” and “exercise
of choice and control through independence and access to
information”.

This schedule was then used in interviews with users, other people
with a visual impairment and key stakeholders to consider how
important these needs were and how they could be best met.

The results have to be analysed carefully as three-quarters of the
existing users were over 70, all were white and only a quarter had
become visually impaired under the age of 60. In contrast, the
potential users were more evenly spread in age, included people
from ethnic minorities and 43 per cent were under 60 when they
became visually impaired. However, the ranking of the seven needs
by the two user groups has some similarities and shows a marked
contrast with the stakeholder ratings.

For example, both user groups ranked “meeting people and
friendship” as their most important need, whereas this is placed
fifth by stakeholders. Stakeholders ranked “re-learning how to
carry out everyday tasks in your home” as third, whereas this is
seventh and fifth in the two user group lists. How might such
differences be explained?

One possibility is that long-term services for people with a visual
impairment are not considered a care management priority by many
stakeholder organisations. Thus their focus is on the
practicalities of information, equipment and doing things in the
home rather than longer-term concerns such as social contact and
talking about personal feelings. A second possibility is more
fundamental. Michael Oliver(4) has argued that professionals tend
to define outcomes in terms of people being able to care for
themselves (cooking, washing, shopping etc) whereas disabled people
talk of being in control of their lives.

The views of many of the users in this research reflected the
thesis of the social model of disability(5) which is that it is the
way services are run that disables people rather than their own
individual characteristics. Thus users suggested ways in which taxi
drivers, neighbours and shop staff as well as professionals might
be made aware of how they routinely exclude them, and how
volunteers could be trained to bring what they see and read to
life, acting as “spontaneous sharers”.

The evaluation led us to make two distinct sets of recommendations.
The first related to strategic developments of the services and the
second to operational improvements. Our overarching strategic
recommendation was that the purposes and aims of the services
should be expressed in terms of outcomes for people with a visual
impairment rather than services. Furthermore, we argued that
outcomes should both meet individual needs and promote the
inclusion of visually impaired people in mainstream provision,
reflecting the social model of disability. Examples included
training of staff in leisure, libraries, supermarket and taxi firms
as well as health and social care about how to include people with
a visual impairment.

This could be supported by individualised programmes for people
with a visual impairment which empowered them to access relevant
mainstream services. Services also needed to address a broader
range of user needs, complementing the existing focus on overcoming
social isolation. These might include music, arts or sports
activities, preparation for employment and the development of
independent user-led groups.

In relation to community capacity, we found examples of other local
organisations that had successfully recruited up to 500 volunteers
providing services such as individual and group support and
transport. These organisations invest significantly in recruiting
and training their volunteers by employing volunteer
co-ordinators.

Operationally, we developed an outcome-focused assessment framework
for use by staff and service users working together based on the
seven needs outlined above. The resulting action plan is as likely
to involve linking users with other groups and services in the
community as direct service provision by Pocklington. Services
would help people to maintain their independence and live active
lives within their own communities and work with relatives and
friends to help them maintain and develop their relationships with
people with a visual impairment. 

MARTIN WILLIS is senior lecturer at the Institute of Local
Government Studies. Graeme Douglas and Sue Pavey are research
fellows at the Visual Impairment Centre for Teaching and Research –
both at the University of Birmingham

Training and learning
The author has provided questions about this article to
guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl
and individuals’ learning from the discussion can be registered on
a free, password-protected training log held on the site. This is a
service from Community Care for all GSCC-registered
professionals.

Abstract
The government’s plans for adult social care focus on
outcomes for service users. The research outlined here demonstrates
how a user-led understanding of outcomes for people with a visual
impairment can be developed into strategic policies and practice.
These should aim to empower users in achieving independence.

References
(1) R Long, J Crews and R Mancil, “Creating measures of
rehabilitation outcomes for people who are visually impaired,”
Journal of Visual Impairment and Blindness, Vol 94/5, 2000
(2) Social Policy Research Unit, Introducing an Outcome Focus into
Care Management and User Surveys, University of York, 2000
(3) Social Services Inspectorate, A Sharper Focus: Inspection of
Services for Adults who are Visually Impaired or Blind, Department
of Health, 1998
(4) M Oliver, The Politics of Disablement, Macmillan, 1990
(5) Social Services Inspectorate, Independence Matters: An overview
of social care services for physically and sensory disabled people,
Department of Health, 2003

Further information
www.pocklington-trust.org.uk

Contact the authors
Contact Martin Willis by e-mail at m.h.willis@bham.ac.uk or
Graeme Douglas by e-mail at g.g.a.douglas@bham.ac.uk