NHS 1986(PCS)35

8 December 1986

Dear Colleague

REGISTRATION OF BLIND AND PARTIALLY SIGHTED PEOPLE

Summary

1. This circular notifies Health Boards and local authorities of an amendment to Form BP1 used for the medical certification of blind or partially sighted persons in order to further assist such persons to qualify for Severe Disablement Allowance. It also requires local authorities to have particular regard to the need to maintain registers or other records of blind and partially sighted persons in their areas so that a simplified procedure for "passporting" blind and partially sighted persons claiming Special Disability Allowance can be brought into operation in Scotland.

Background

2. Persons in England and Wales who are blind and partially sighted are regarded as meeting automatically the 80% disability requirement necessary to qualify for Severe Disablement Allowance if their names are included in a register kept by a local authority under Section 29 of the National Assistance Act, 1948. In Scotland Section 29 of the 1948 Act was repealed by the Social Work (Scotland) Act 1968 and local authorities no longer have a duty to maintain registers of blind and partially sighted persons. Nevertheless, authorities have powers to make such records (including registers) as are necessary for the discharge of their functions and maintain registers in terms of the 1968 Act and they also have a duty in terms of the Chronically Sick and Disabled Persons (Scotland) Act 1972 as read with the 1968 Act to inform themselves of the numbers of chronically sick and disabled persons in their area.

3. Despite the repeal of the specific statutory requirement to keep registers of persons with various categories of disability by virtue of the 1968 legislation, it is understood Scottish local authorities still maintain registers (or other comprehensive records) of blind and partially sighted persons in their area, either directly or through some agency arrangement. The submission of annual statistical returns on the numbers of blind persons is presumed to be based on such records. In order to extend to Scotland provision for the automatic "passporting" of registered blind or partially sighted claimants through the 80% disablement qualifying condition for Severe Disablement Allowance, the Department of Health and Social Security have laid before Parliament an amendment to the existing Regulations covering

Severe Disablement Allowance which will cover persons in Scotland who meet the definitions described in the Annex to this Circular. The effectiveness of the new arrangements will depend very largely on the maintenance of the existing registers and it is therefore essential that these should continue to be carefully maintained and should be comprehensive, accurate and accessible for operational purposes.

4. There is therefore a need to ensure that registers provide a wholly reliable record of whether a blind or partially sighted person has been registered and that confirmation of this is provided to the person concerned in the form of a certificate. It is not however a feature of the DHSS regulations that the registered person should necessarily provide written evidence of disability in order to qualify for SDA on the basis of "passporting". Completion of the relevant box of DHSS form SDA1 indicating that the claimant is registered with a particular local authority (which would include an agency acting on behalf of a local authority) is all that is normally required for admission to this particular allowance without further medical evidence. Production of a certificate may however be required in other circumstances for a registered blind person to qualify for other benefits, concessions and allowances, and authorities are urged to continue the practice of providing certificates on established lines in the interests of such persons.

5. It is also necessary to ensure that from 8 December 1986, the date of the coming into force of the amending DHSS Regulations, ophthalmologists in Scotland work on the same definition of blindness and partial sight as their counterparts in England and Wales so that the cases of blind persons in Scotland seeking entitlement to Severe Disablement Allowance can be dealt with in the same way. In this connection it is necessary that the definitions of blindness and partial sight set out in the Annex to the Circular should be included in the text of the existing Form BP1 issued under Circular 1982(PCS)36. These definitions follow earlier guidelines set out originally in DHSS Circulars No 71/1954 and No 51/1955. Copies should be made of the Annex and attached to existing stocks of Form BP1. Form BP1 itself will be reprinted as soon as possible, but as other amendments to the form are currently being considered, reprinting of the form will take a little time.

Contact Point

6. Please direct any enquiries about this circular to Miss Mary Forker, Social Work Services Group, Room 44, James Craig Walk, Edinburgh EH1 3BA

(telephone 0131 244 5456).

Yours faithfully

GAVIN ANDERSON

Definition of blindness

1. The required qualification for inclusion as a blind person in any register maintained by or on behalf of a Regional or Islands Council in Scotland under arrangements made by the Secretary of State for Scotland is that the person is "so blind as to be unable to perform any work for which eyesight is essential". In considering this matter there are two important points to be noticed, viz:

(i) the test is not whether the person is unable to pursue his ordinary occupation or any particular occupation, but whether he is too blind to perform any work for which eyesight is essential; and

(ii) only the visual conditions are taken into account and other bodily or mental infirmities are disregarded.

2. The principal condition to be considered is the visual acuity (ie, the best direct vision obtainable with each eye separately or both together, whether both are present, as tested by Snellen’s type with focus properly corrected), but regard must also be paid to the other conditions set out below.

3. The persons examined may be classified in three groups, as follows:

(a) Group 1 - Below 3/60 Snellen

In general, a person with visual acuity below 3/60 Snellen may be regarded as blind. In many cases, however, it is desirable to test the vision at one metre and not to regard a person having acuity of 1/18 Snellen as blind unless there is also considerable restriction of the visual field. (Note - 1/18 indicates a slightly better acuity than 3/60 but as the standard test types provide a line of letters which an eye possessed of full acuity should read at 18 metres, there is some convenience in specifying 1/18).

(b) Group 2 - 3/60, but below 6/60 Snellen

A person with visual acuity of 3/60 but less than 6/60 Snellen -

(a) may be regarded as blind if the field of vision is considerably contracted but

(b) should not be regarded as blind if the visual defect is of long standing and is unaccompanied by any material contraction of the field of vision eg in cases of congenital nystagmus, albinism, myopia, etc.

(c) Group 3 - 6/60 Snellen or above

A person with a visual acuity of 6/60 Snellen or better should ordinarily not be regarded as blind. He may, however, be regarded as blind if the field of vision is markedly contracted in the greater part of its extent, and particularly if the contraction is in the lower part of the field, but a person suffering from homonymous or bitemporal hemianopia retaining central visual acuity of 6/18 or better is not to be regarded as blind.

4. NOTES

(a) The question whether a defect of vision is recent or of long standing has a special bearing on the certification of blindness. A person whose defect is recent is less able to adapt himself to his environment than is a person the same visual acuity whose defect has been of long standing. This is specially applicable in relation to Groups 2 and 3.

(b) Another factor of importance, particularly in relation to Group 2, is the age of the person at the onset of blindness. An old person with a recent failure of sight cannot adapt himself so readily as can a younger person with the same defect.

(c) On rare occasions cases will arise which are not precisely covered by the foregoing observations, and such cases must be dealt with according to the judgement of the certifying ophthalmic surgeon.

(d) In making recommendations about persons up to and including the age of 16, examining ophthalmologists should bear in mind that there are other factors which may influence local education authorities in their decision about the special educational treatment to be provided.

Definition of partial-sight

5. Partial sight is not defined by statute but the Scottish Office has advised that a person who is not blind within the meaning of paragraph 1 above but who is, nevertheless, substantially and permanently handicapped by congenitally defective vision or in whose case illness or injury has caused defective vision of a substantial and permanently handicapping character is within the scope of the welfare services which the local authority are empowered to provide for blind persons - but this does not apply to other benefits specially enjoyed by the blind, eg Supplementary Benefit or Income Tax concession where eligible.

6. The following criteria should be used as a general guide when determining whether a person falls within the scope of the welfare provisions for the partially-sighted, as well as in recommending, where the person is under 16 years of age, the appropriate type of school for the particular child concerned:

(i) for registration purposes and the provision of welfare services, those with visual acuity -

(a) 3/60 to 6/60 with full field;

(b) up to 6/24 with moderate contraction of the field, opacities in media, or aphakia;

(c) 6/18 or even better if there is a gross field defect, eg hemianopia, or there is marked contraction of the field as in pigmentary degeneration, glaucoma, etc.

(ii) for children whose visual acuity will have a bearing on the appropriate methods of education -

(a) severe visual disabilities - to be educated in Special Schools by methods involving vision - 3/60 to 6/24 with glasses;

(b) visual impairment - to be educated at ordinary schools by special consideration - better than 6/24 with glasses.

7. NOTES

(a) Infants and young children with congenital anomalies, including visual defects, unless obviously blind should be classed as partially-sighted.

(b) At age 4 and over binocular corrected vision should be the criterion.

(c) All in (ii) (a) and (b) above should be re-examined every 12 months - or earlier if there is reason to suspect any worsening.

(d) In making recommendations about persons up to and including the age of 16, examining opthalmologists should bear in mind that - as with blindness - there are other factors which may influence local education authorities in their decision about the special educational treatment to be provided.