NHS CIRCULAR NO: 1982(GEN)7

19 March 1982

Dear Colleague

CARE OF THE EYESIGHT AND HEARING OF ELDERLY AND DISABLED PEOPLE

Summary

The purpose of this Circular is to ask Health Boards and Local Authorities to ensure that residents of long-stay hospitals and homes have their sight and hearing tested when considered necessary and are provided with such aids as are clinically required.

Background

The abilities to see and hear clearly are important to everyone, but to the elderly who frequently have an impaired sense of balance and slow reflexes, they are essential if falls are to be avoided and the pleasures of reading, writing, television and social activities enjoyed. Unfortunately, defective eyesight and hearing are often accepted by many elderly people as an inevitable concomitant of ageing. They may also be exacerbated by certain drugs. The problem may not be brought by the patient to the attention of attending staff who should therefore be watchful for signs of increasing impairment of vision and/or hearing so that any necessary remedial action can be arranged.

Hospital Patients

The hospital eye service is responsible for meeting the ophthalmic needs of hospital in-patients, and where necessary, for making arrangements for this work to be undertaken by general practice opticians. Boards are asked to encourage hospital medical and nursing staff to acquaint themselves with the services available through the hospital eye service.

The hospital eye service will normally sight test and provide optical appliances as necessary from within its own resources, but, where this is not practical hospital administrators may be asked to contact the local Area Optical Committee which represents local general practice opticians in the area, to ascertain whether a local optician or opticians would be willing to visit the hospital concerned and undertake sight testing and dispensing of glasses for patients requiring them. A hospital in-patient is not required to pay statutory charges for lenses and frames.

1. Hospital in-patients who appear to be suffering from a hearing impairment should be brought to the attention of a consultant otolaryngologist at an Ear, Nose and Throat Department or hearing aid clinic, who will carry out the examination required for diagnosis which is likely to include audiometric and other tests. It is for the otolaryngologist to determine whether a patient can reasonably be expected to benefit from the use of a National Health Service hearing aid and which type is best suited to his needs.

Residential Establishments under the Social Work (Scotland) Act 1968

Responsibility for ensuring that arrangements are made for the health needs of residents in accommodation under the Social Work (Scotland) Act 1968 rests with the local authority and with managers of voluntary establishments. Persons in charge of these homes may contact the patient's general medical practitioner to ask for ophthalmic services to be provided by the hospital eye service, or arrange with local general practice opticians either for residents to visit the opticians' premises or for the opticians to visit the home; the latter service is not available under the health service and the optician is entitled to charge for all such visits. Residents who may benefit from a hearing aid should be seen by their general practitioner who will, if necessary, arrange for the patient to be examined at an Ear, Nose and Throat (ENT) Department. If a hearing aid is recommended, the ENT Department will refer the patient to a hearing aid clinic, where the appliance will be fitted and supplied. If the patient is unable to attend the hospital or clinic, arrangements can be made for domiciliary visits by these specialist services.

Residents of social work establishments are liable to pay statutory lens and frame charges but may be entitled to claim exemption. Information on eligibility for exemption is contained in leaflet G11 which is available from Post Offices and Social Security Offices. National Health Service hearing aids are provided, serviced, maintained and supplied with batteries all at no cost to the patient.

Persons Living at Home

It is important that domiciliary health and social work personnel should be on alert when visiting house-bound elderly and disabled people, especially where they are living alone, to discern the presence of hearing or visual deficiencies which have not been previously recognised or, where recognised, to ensure that the possibility of obtaining remedial help has been explored. Those who are house-bound and are thought to need sight testing but are unable to visit an optician, even with the aid of voluntary transport, can ask the general practitioner to arrange for a visit from the hospital eye service. Some general practice opticians are prepared to visit people, living in their own homes, whose mobility is severely restricted, but as this service is not part of the health service, the optician is entitled to charge the patient for his visit.

House-bound patients are liable to pay the statutory lens and frame charge, but may be entitled to claim exemption. The arrangements for the audiological examination of the elderly and disabled who are house-bound are as outlined in paragraph 6 above.

Contact Point

Please direct any enquiries about this circular to Miss Mary Forker, Social Work Services Group, Rm 44, James Craig Walk, Edinburgh EH1 3BA (telephone 0131 244 5456).

Yours faithfully

GAVIN ANDERSON