Improving Lives the facts

Blindness and partial sight are serious,permanent conditions

1.7 millionin the United Kingdom

Two thirdshave another disability or serious health problem such as deafness, arthritis,angina or diabetes.

Six inevery ten never go out on their own

Increasedassociated risk of mortality

Increaserisk of falls and injuries

Increasedrisk of isolation and depression

and the numbers will rise as the numberof older people rise.

90% areaged 60 and over

Affectingover 3 per cent of the population

Affectingone in five people over the age of 75

Increasedincidence in people of South Asian or African Caribbean descent

By 2031 40% of the UK will be aged 60 or over

Affectingat least 2.5 million people within thirty years.

However most visually impaired people arenot getting the help they need

Over twothirds of those eligible are not registered as blind and partially sighted

Themajority of these people are not in contact with any social care services

88% of people over 65 with cataracts are not in touch witheye services.

75% of people over 65 with glaucoma have no contact with eyespecialists.

In oneLondon borough, a person waited for 3 years between being notified that theywere on the register and receiving a needs assessment.

because visual impairment is not givensufficient weight

Sightproblems are not treated with sufficient importance or urgency by GPs whendeciding whether to refer patients to hospital eye clinics.

Ageismwithin primary care means that many older people are informed that sight lossis a normal part of the ageing process, and are not encouraged to see aspecialist at an eye clinic.

Many peoplehave to spend long periods on waiting lists as they are of low prioritycompared to those whose conditions can be treated

Tighteningeligibility criteria discriminate against blind and partially sighted people byfailing to address their critical needs, such as difficulties in accessinginformation, keeping a clean home and basic home maintenance.

services are not sufficiently resourced

The numberof specialist practitioners in social care and rehabilitation for visuallyimpaired people is woefully low.

Eachprofessionals case load is so large that the amount of intensive and responsivecare that people are given is not satisfactory to either them or theprofessional.

There is nocurrent capacity to provide services for the majority of eligible people not intouch with health and social care agencies.

Chargingpolicies are punitive to older blind and partially sighted people, over 90% ofwhom are on an income of less than half of the national average.

are not sufficiently accessible

Hospitaleye clinics are not always accessible to blind and partially sighted people,with many not even getting the basics right, such as ensuring that theirappointments system caters to people who cannot access normal print.

Theobtaining of low vision aids provision (free from a Low Vision clinic but fullycharged from a community optometrist) is extremely confusing to service users.

do not provide users with adequatesupport and information

People areoften not given information about their eye condition, about the benefits ofregistration and about the other services that may be available

Many peoplewith age-related eye conditions are told that there is nothing that can be donebecause of their age

Only one infive people attending eye clinics are given the opportunity of someone to talkto, although over seven in ten said they wanted that support to cope at a timewhen they may well be told they are going blind.

are not sufficiently flexible

Most sightloss in older people is progressive and degenerative, but most rehabilitativehelp is given in the time just after registration.

There is adistinct lack of judiciously timed rehabilitative intervention at times ofchanges in eye condition, health and social and economic circumstance (e.g.death of spouse, moving house, onset of arthritis).

and are not delivered to universal carestandards.

Some lessregulated professions like rehabilitation have an extremely high diversity ofpractice standards

Serviceusers are often aware of inconsistencies in registration decisions, withconsultants saying that the guidance they must follow is not entirely clear

Needsassessments are service-led, fitting the client into existing modes of servicedelivery as opposed to services responding to client needs.

Services vary hugely around the country

Standardsof Low Vision service have enormous geographical variations

Some areashave community based rehabilitation officers, some do not.

Chargingfor home care services varies widely between local authorities.

with professionals often notcommunicating with each other

In manyareas, links between health, social services and the voluntary sector are poorto non-existent, meaning no continuity of care, leaving newly certified blindand partially sighted people with no idea as to what should happen next.

Optometristsand rehabilitation officers often receive only partial information followingregistration.

making it difficult for skilled anddedicated professionals to give people a good service.

Theemotional and psychological impact of sight loss and certification as blind orpartially sighted can be earth shattering, yet many feel that this went largelyunrecognised. The attitudes and approach of medical professionals is key to theway people react to sight loss and certification.

People arenot given sufficient information at the point of diagnosis about their eyecondition and its implications. Nor is this information passed to socialservices during the registration procedure, leaving a critical information gap.

For manypeople, the notification they received from social services, informing themthat they were registered as blind or partially sighted was totally impersonal,and added to the emotional and psychological problems that they wereexperiencing.

Servicessuch as home care are cut without consultation with the client or re-assessmentof their needs, sometimes to the point of the service becoming ineffectual.

Early diagnosis, good rehabilitation andsupport can make a real difference

Ifdetection rates were improved, hundreds of thousands of people could retainuseful vision for a number of years, saving the state vast quantities of moneyon subsequent treatment, hospital and nursing home admissions.

Prompt andeffective rehabilitation has proved extremely successful in helping visuallyimpaired people of working age to remain in employment and remain economicallyproductive

Wherecommunity based visual impairment support services exist people are retainingtheir independence and dignity for far longer.

and save a lot of money

The cost of residential care has been estimated to be 27%higher than it would have been if home care provision had kept pace with therise in the older population.

The risk of hip fracture is doubled with poor and moderatelyimpaired vision.

The cost tothe NHS of treating sight related fall and injuries (estimated in one study as221 million) is far greater than the amount spent on rehabilitation andprevention (25 million)

if all services are seen as a vital cogin the cycle of care

The statusand qualifications of rehabilitation officers are often not recognised by otherprofessionals.

Manyconsultant ophthalmologists will not certify because they believe stigma willbe too high, benefits of certification too low or for perverse incentives (suchas guilt at the certification fee).

wheremedical intervention is no longer possible the GP still has a role in assessingpsychological or emotional interventions.

optometristssay that they would welcome a more structured and formal place in the system ofcare.

and blind and partially sighted peopleare involved

blind andpartially sighted people have the best overview of the number of differentservices on which their independent functioning depends.

servicesplanned for blind and partially sighted people without their direct involvementare unlikely to meet their needs effectively or efficiently.

Mostgeneric service providers in both health and social care have not receivedtraining in visual impairment awareness making it more important to consultblind and partially sighted people about their experiences.

and examples are given in this reportof how the right support at the right time can make all the difference.

Those whohave received services such as Low Vision and rehabilitation have generallyfound the experience to be positive and transforming.

Many peoplehave reported how feelings of despair and grief have been overtaken by optimismand motivation with the help of services specifically designed to give supportand training about how to cope with sight loss.