‘Visual impairment workers face crisis despite Care Act 2014’s emphasis on their role’

By Simon Labbett, chair, Rehabilitation Workers Professional Network

In December 2013, the Association of Directors of Adult Social Services (Adass) re-issued its Position statement on visual impairment rehabilitation in the context of personalisation. At the time one wonders how much attention was paid to it or its key assertions that, “unlike generic reablement programmes, visual impairment rehabilitation is a specific intervention”, and that such interventions “cannot necessarily reach a successful conclusion within a six-week timeframe”.

Now the 2014 Care Act validates this approach in full in its statutory guidance. Not only is the Adass guidance cited directly in section 22 of the guidance, but paragraph 2.61 of the guidance, on prevention, also reiterates both the specialist nature of visual impairment rehabilitation and the time-limited, but not time prescribed, approach to its intervention.

The Adass guidance, tellingly, adds: “Local authorities should consider securing specialist qualified rehabilitation and assessment provision…Certain aspects of independence training with blind and partially sighted people require careful risk management and should only be undertaken by a fully qualified Visual Impairment Rehabilitation Officer (ROVI).”

Low numbers of rehab officers

Given the high incidence of visual and hearing loss among the older population and the learning disabled population – people with learning disabilities are 10 times ore likely to have serious sight problems than other people -,and the unquestionably disabling nature of blindness and deafblindness, you might wonder how many rehabilitation officers there are in your local authority to meet this demand.

Whereas there may be some thirty occupational therapists, and maybe forty or fifty social workers, the average number of rehabilitation officers per authority is three!

According to a Freedom of Information Act request by the Royal National Institute for Blind People (RNIB) this year, there are some forty local authorities that have at most one solitary worker (or less). But how many should there be? A benchmarking exercise by the Welsh Local Government Association in 2006 recommended a good practice ratio of one full-time equivalent ROVI to every 50,000 of the population. The population of most London boroughs, some of which only employ one ROVI, is about 200,000.

Now consider that the referral rates for someone being identified as blind or partially sighted in that same local authority will be around 200 per year. Around 120 of these will be formally registered via the statutory Certificate of Vision Impairment (CVI). Again, the Care Act guidance is clear (22.16) that “upon receipt of the CVI the local authority should make contact with the person within two weeks” to arrange their inclusion on the council’s register of sight-impaired people. Where there is appearance of need for care and support, the council “must arrange an assessment of their needs in a timely manner”.

Phone or non-specialist assessments no solution

How can a solitary worker (or even two) assess and manage a programme of rehabilitation for a workload of this size and with clients trying to rebuild their lives after losing their sight?  Screening assessments by phone is seen as a solution. It would be a brave service manager who felt it appropriate to assess someone who is going blind or blind and deaf over the phone or by using someone who is not a trained in specialist solutions.

To complicate service provision further, vision and hearing loss are frequently encountered in people with poor cognitive function. Assessing and providing independence skills in these settings requires specific communication skills and a clear understanding of risk and safeguarding.

I would suggest there is a workforce crisis of service-threatening proportions. Visual and dual sensory impairment specialists have seen their skills marginalised. This is partly because of a poor understanding of how blindness affects physical function and wellbeing and partly because sensory teams have been lost in favour of reablement teams, where some managers may feel inclined to skill-up generic workers on inadequately short courses.

Short-term approach

Very few social service departments are supporting home-grown workers in their teams to train to be ROVIs. Poaching workers from neighbouring authorities may have worked in the past but there are not enough specialists out there to make this practical any more.  This short-term approach seems bizarre when the initial training costs will be more than recouped though the savings these workers make through falls reductions, smaller care packages and lower costs attributable to depression and social isolation.

One final thought on the Care Act that service users may want to use to encourage local authorities plan ahead is section 2.37 “Local authorities should put in place arrangements to identify and target those individuals who may benefit from particular types of preventative support”.

For more information on visual impairment rehabilitation and information on qualifying as a rehabilitation officer, see the Rehabiltation Workers Professional Network website. www.rwpn.org.uk   This theme will also be covered at the Vision UK conference, in London on 18 June.