Chapter 2 Services For People With A Visual Impairment

20. In this chapter we introduce the national voluntary organisations working with people with a visual impairment. We also examine local authorities' performance in assessing need and their provision of key services in relation to information, advice, equipment, rehabilitation and mobility. Local authorities provide specific services and information about these and the services of others under the relevant legislation (see Annex 1). The 1995 Disability Discrimination Act demands that information is provided in accessible formats.

National Voluntary Organisations

21. National voluntary organisations for people with a visual impairment are largely organised on a UK basis. GDBA, in addition to its traditional work, has been instrumental in providing substantial capital and revenue funding for local projects. These have included the provision of premises, rehabilitation staff and low vision equipment, usually in partnership with local societies. GDBA's contribution to the development of some resource centres in the East of Scotland has been significant. It also underwrites the Glasgow School for Vision and Rehabilitation Studies which trains rehabilitation workers.

22. RNIB are a major representative organisation for people with a visual impairment providing a wide range of services. Their direct expenditure on services in Scotland is approximately £2 million per annum with additional input in the form of nationally sourced services, e.g., Talking Books, publications in Braille. They are major partners in the Glasgow Resource Centre where they provide the specialist equipment as well as a multi-media production facility, support for students and for those seeking employment. RNIB has developed the Springfield Service Centre in Glasgow and has supported specialist employment and technical projects elsewhere.

23. SNFWB operates on a Scotland wide basis without full-time paid staff. At present it undertakes tasks that are proportionate to its limited resources. SNFWB have developed standards (note 8) for organisations providing services for people with a visual impairment. Membership includes both voluntary and statutory, national and local organisations.

Assessing Need

24. Most people with a visual impairment will receive a clinical assessment, normally from an ophthalmologist, in a hospital eye clinic. This assessment can lead to certification (of blindness or partial sight). The certificate is called the BP1. When the details on this certificate pass to the local authority, if the person wishes, they can be put on a register and they are then considered to be a registered person. The case for registration made by authorities and organisations representing people with a visual impairment, is that it brings tangible benefits to people such as social security benefits, tax relief, travel and postal concessions. While there are no direct social work service benefits flowing from registration, it can serve as a way of identifying people who may benefit from social work support. However, reliance on this procedure as a gateway to social work services would be misplaced as some young and older people are reluctant to be labelled disabled or blind and do not wish to be registered.

25. The importance of an early visit by social work staff soon after registration has been stressed by people who use the services, social work and health staff alike. This visit can provide practical help and encouragement, advice on welfare benefits, provision of equipment, counselling or rehabilitation, including mobility services.

26. We found a wide variation in the time that elapses between the local authority's (or agent's) receipt of the BP1 and the first contact made by social work staff with the registered person. The gap in time could be 2 weeks or as long as 4 months.

27. From our examination of the files we also found different practices in relation to this first contact:

• no social work assessment record - only a note of a visit and action taken;

• a tickbox checklist of specialist services available;

• a standard social work assessment proforma oriented mainly to people with visual impairment, requiring boxes to be completed, with limited space for comment;

• a full community care assessment proforma, including the needs of carers and supplemented by a considered written contribution.

28. The first practice was found mainly amongst in-house specialist services and was illustrated by one person in our survey who said:

"There was a nice lad who left a pack of information, but no-one ever called again. Someone should be in touch to at least ask if I require help."

The second approach was common to many in-house services, and to some contracted services. This is acceptable where the needs of the visually impaired person are straightforward, for example, for information or simple equipment. However, we did not find anything in the files that allowed us to conclude whether or not a fuller assessment was required. Nor was there any indication of the assessor having made that judgement.

29. Our examination of the case files - supported by some of the interviews - suggests that a significant minority of people with a visual impairment required a fuller assessment (and support) than had been provided. For example, one case file told of a blind older woman with multiple sclerosis who was depressed. The file contained no comprehensive assessment of the person's needs, although boxes relating to the equipment and information provided had been ticked on a standard assessment proforma.

30. Most assessments are undertaken by specialist staff unless the person has severe additional disabilities or is subject to either statutory child protection or mental health intervention.

31. The responses to our local authority questionnaire indicated that the skill mix in specialist local authority teams varied. It included qualified social work (note 9), rehabilitation staff, unqualified social workers and technical support staff. The teams have, therefore, differing abilities to undertake comprehensive assessment. However, we found little evidence that specialist teams used other qualified staff to support their assessment work.

32. People with a visual impairment who had additional disabilities, could be assessed at the RNIB Springfield Service Centre. The Centre focuses particularly on the impact of visual impairment on the person's other disabilities. In 1997 the Centre provided up to 14 places per day for people largely from the West of Scotland. Attendees come on average for 1 or 2 days per week. The costs of approximately £86 per day have forced some authorities to withdraw placements due to financial constraints.

33. Visual impairment is often caused by a degenerating condition and impairment may become partial or total loss of vision over time. This may require a regular return to an eye clinic and highlights the importance of local authorities or their agents conducting regular reviews of social care services to ensure they are still adequate to meet people's needs. The highest number of new registrations relate to older people with deteriorating eyesight. One study (note 10) of people over the age 65 with a visual impairment demonstrates close links between developing visual impairment and other disabilities. Sixty three per cent of older people, with a sight problem, reported having more than 5 other difficulties in sustaining their daily living. This study highlights:

• the number of older people with poor or deteriorating eyesight living alone (almost half of the sample in this study);

• the impact of sight loss on managing daily living;

• the importance of the physical environment (especially lighting);

• the loneliness and anxiety that springs from restriction in mobility;

• a low take-up of aids and equipment; and
• a low expectation of improvement in their quality of life.

34. A recent RNIB survey (note 11) also highlights the varied needs of older visually impaired people. The 514 older blind and partially sighted people surveyed had 4 key areas of concern:

• care and daily living needs;

• mobility;

• isolation;
• poverty and benefits.

The survey confirms that many social services and social work departments are failing to deliver the necessary help and care. More than one in 5 of the sample had never received a visit from social services and almost a quarter had not had a visit for more than a year.

35. Both local authority in-house and externally contracted services recognise the importance of conducting annual reviews of people's needs but are finding it increasingly difficult because of the many demands on their resources.

The Services

36. Many people we spoke to who received services whether in-house or contracted were very positive about the service they received. "Efficient, friendly and professional", was one comment.

• Fifty-two people (67%) said they could access services;

• Forty-eight people (62%) said that they felt the service to be professional and thirty-nine (50%) said it was what they expected;

• Forty-five people (58%) believed the services to be co-ordinated;

• Forty people (51%) said the provision was timely;

37. The following chart illustrates the overall quality ratings for the six local authority inspection sites.

Figure 1. Overall Quality of Service Provision

38. The chart suggests that 3 out of 4 people receiving services consider them to be of "good" or "good-medium" quality. Nevertheless, these quality ratings need to be treated with caution as our survey also provided evidence that expectations of the services may be low.

The following services were provided to our interviewees:

• advice on benefits (58%);

• some other form of social care (56%);

• specialist equipment (50%);

• home care (33%);

• an assessment for mobility and home skills training (31%);

• meals-on-wheels (15%).

Information and advice

39. Information and advice on services is a core need of many people with a visual impairment. The RNIB Needs Survey (note 12) indicated a significant lack of knowledge amongst people with a serious visual impairment about the services available to them.

40. We asked people who used the services to assess the quality of the information provided by the social work department or agency.

• Forty-eight people (62%) felt the information was relevant to their circumstances.

• thirty-five people (45%) received information while getting services;

• thirty-two people (41%) said the information was provided at the appropriate time.

• twenty-six people (33%) received information before getting a service;

• only 10 people (8%) had received information regarding a complaints procedure; and,

• only 4 people (5%) had received any information about their statutory right of access to files held on them.

41. Information about specialist services provided to people with a visual impairment was better in the larger authorities. Information about other social work services was poorer than information about specialist services in all the authorities. The availability of information in accessible formats was also poor. Of the authorities returning our questionnaire, 19 said they produced information in large print; 15 produced it on audio-tape and 11 published information in Braille. Of those people surveyed who had received information in written form, less than a quarter said they were able to read it. Information was rarely available in Braille, large print, audio-tape, Moon, on computer disk, or thermoform.

42. The range and quality of information available in the authorities we visited varied considerably. We were impressed by the availability of information in Aberdeen, Fife and Glasgow. In each of these areas there is a resource centre which has the capacity to develop, produce, distribute and display literature and provide this in relevant formats, including audio-tape. Information services for people living in Argyll & Bute rely on close links with Glasgow's Resource Centre. The council does not purchase a service from the Resource Centre but they are joint users and fund it, according clients unlimited access. Moray's services are provided by Grampian Society for the Blind (GSB), and have a close link with information sources at the Moray Resource Centre. East Ayrshire Council has a new service which has yet to develop information services: a new full time post devoted to this work, across all sensory impairments, has recently been filled. The newsletter of GSB received consistent praise from recipients as it provides a source of information and stimulation to many people.

Equipment

43. The provision of appropriate environmental aids and equipment can make an important contribution to the quality of people's lives, including promoting their safety and independent living. Aids vary from the straightforward, such as a frame for cheque signing, to the more sophisticated such as a computer.

44. Where resource centres are able to display equipment and provide a local facility for Low Vision Aids (LVAs), this is ideal. In many areas people with a visual impairment do not have easy access to resource centres or have access to centres with a limited range of provision. There are resource centres in Aberdeen, Fife (Kirkcaldy) and Glasgow (at the new Partick Centre). Each is able to display equipment, and in particular provide a local facility for LVAs. These facilities were not available in Argyll & Bute and East Ayrshire. The sensory impairment team in Argyll could access the facilities at the Partick Centre, but travelling long distances is a problem for many older people. East Ayrshire is developing a sensory resource within the Dalsalloch Centre at Auchinleck. People with a visual impairment in Moray may use the Moray Resource Centre where there are limited facilities, together with GSB's mobile resource centre.

45. All authorities were asked to provide information about budgets for the provision of equipment. Our analysis of responses suggests that in cash terms there is a considerable variation in the equipment budgets allocated by authorities.

46. The amount of equipment that people with a visual impairment are able to obtain is not related to the size of equipment budgets. In Fife, the Society for the Blind receives £2,250 per annum from the council and this is used primarily to purchase low cost items. These items would be uneconomic to sell and are provided to people with visual impairments without charge. Other equipment is normally purchased by people themselves either from the Society's stock, or where available at a lower price, from high street retailers.

47. Generally, once they were assessed, people got low cost equipment quickly. Equipment and resource centre staff adopted practical and pragmatic ways of ensuring that such equipment was provided, either by way of loan or by means of a purchase scheme based on people's income. By contrast, we were consistently told of problems in the providing of expensive, often hi-tech equipment, such as home computers to assist with school work.

Rehabilitation and mobility

48. There are specific and practical ways to help people with a visual impairment to sustain both a high quality of life and maintain their independence and mobility. This is the work of rehabilitation and mobility staff who can provide training in new skills and who often advise on the necessary equipment.

49. A full rehabilitation and mobility service would include a number of components. We asked all local authorities whether people with a visual impairment had access to such support in their area. Table 2 illustrates the responses from local authorities about whether services were provided directly.

Service

Number of local authorities
providing

No provision

Rehabilitation

26

0

Sighted guide training

21

5

Long cane training

21

4

Low vision equipment

19 + 5*

2

Communication

25 + 1*

0

*Health service provided

Table 2 Provision of rehabilitation and mobility services

The table suggests that most authorities provide mobility training but that the provision of this service is uneven.

50. Our survey of people who used the services indicated a higher level of dissatisfaction with rehabilitation and mobility services than with services overall. Twenty percent of those asked felt rehabilitation services were poor, compared to 12% who said that services overall were poor. These findings are reinforced by RNIB assertions that "less than half of those registered as blind have received mobility training" (note 13). One person commented:

"Steps and kerbs make me feel nervous. I know I am on a waiting list [for training] but I do not want to stay sitting in doors."

51. The non-availability of a service and the lengthy waiting periods are likely to be due to the low level of rehabilitation and mobility officer posts, evident within in-house specialist teams in local authorities. Of 14 local authorities providing services directly, 3 authorities had no qualified rehabilitation and mobility staff, 9 had the equivalent of one person full time, and only 2 (Glasgow and Renfrewshire) had more than one.

52. Consistent information about staff in contracted out services was not available. The two agencies we visited had contrasting staffing arrangements. In GSB there are more qualified social work staff than rehabilitation officers. In Fife, rehabilitation staff outnumber qualified social work staff.

53. A 1995 telephone survey of Scottish authorities (note 14) concluded that Scotland has a shortfall of 90 rehabilitation officers. In their submission the GDBA (note 15) argued that authorities, or their agents, were meeting their requirements to provide assessments for rehabilitation and mobility, but that the needs of people with a visual impairment were not being met.

Summary

• Over half the people surveyed have positive comments about the service they receive although these findings may need to be treated with caution.

• There is evidence of delays in people being assessed. There is a wide variation in the quality of initial assessments. This makes it difficult to judge whether a more comprehensive assessment is needed but there is evidence that some people are not receiving the full assessment of their social care needs that they require. There are skill deficits in some specialist teams, of either qualified social work or qualified rehabilitation staff. Staff are not undertaking annual reviews.

• Good information services are related to the existence of resource centres for people with a visual impairment. Information about social work services is not always available in appropriate formats.

• Access to resource centres has a significant impact on a person's ability to learn about and test specialist equipment. Equipment budgets are uneven, but this did not have a major impact on individual's accessing inexpensive equipment.

• There is shortage of qualified rehabilitation officers. A few authorities are unable to provide qualified mobility training, and in many there is evidence of people having to wait long periods of time for training support.