Benchmarking Report.
Visual Impairment Benchmarking Study Summary Report.
Executive Summary.
Background.
The majority of us take sight for granted. 90% of the information we receive about our surroundings and environment is visual. People without sight or with partial sight are therefore at an immediate and significant disadvantage in living their everyday lives and fulfilling their individual potential. The effects can be particularly acute when someone loses some or all of their sight suddenly at some stage of their lives.
Some 20,000 people are registered blind or partially sighted in Wales, although it is estimated that there are at least 60,000 more with serious visual impairment but who are not registered.1
In recent years there have been significant strides in the development of policy and service delivery for people with disabilities, which have brought a number of benefits to service users, including vision impaired people. Recent legislation and the rights agenda have triggered considerable progress in this area. However there is still much to be accomplished in the provision of services to meet the specific needs of visually impaired people.
Visual impairment benchmarking study.
This is why in 2001 Wales Council for the Blind approached the
Welsh Local Government Association with a view to establishing a project to
benchmark the service for people with visual impairment, concentrating on social
services. In March of 2003 the ADSS in Wales agreed to support the establishment
of a benchmarking club to look at visual impairment services across Wales. The
project has benefited immensely from the support and direct involvement from the
outset not just of the ADSS, but also the Welsh Assembly Government, SSiW, all
22 Welsh councils and voluntary organisations including RNIB Cymru and local
societies for the blind. The study sits alongside other recent work carried out
by the ADSS on developing standards for sensory disability services, and takes
full account of national changes such as the introduction of the Unified
Assessment Process in Wales.
The study provided a unique opportunity to conduct an assessment and comparison
of current levels of capacity and performance levels across Wales. It has led to
the formulation of recommendations in key areas of service, namely provision of
information, referral, assessment and rehabilitation planning, and services for
children and young people. These recommendations are accompanied by a
comprehensive set of service standards on these service areas, contained in a
series of Good Practice Guides, and designed to help managers and staff plan
improvement in their own local areas.
Visual impairment services in Wales.
Identifying the total need for visual impairment services in a given area presents local authorities with a considerable challenge. It is widely acknowledged that alongside people registered as having a visual impairment, there is likely to be a significant number of people in any location who are not formally registered but who nevertheless experience the limitations of a visual impairment. In some cases this might be due to them not being aware of the registration process, in others there may be a reluctance to admit need and to seek assistance from an outside agency. Authorities need to find effective ways of 'seeking out' these people in order to ensure they receive appropriate help. Currently councils use a range of approaches to do this; however there is a recognised need to identify leading practice approaches and encourage authorities to adopt it in their own areas.
Visual impairment services typically do not enjoy a high profile within authorities or indeed social services departments, in terms of either exposure or resources. Staffing levels vary markedly across Welsh councils, levels having no obvious correlation with identified need in a given area. Nationally, councils are experiencing considerable difficulties in relation to recruitment and retention. One apparent contributory factor is the absence of a consistent approach to continuous professional development.
Service planning and review need to be strengthened, in order to secure appropriate levels of resourcing and ensure continuous improvement in services. Equally, feedback from users needs to be used more effectively to shape services.
Information provision.
Provision of accurate, up to date and timely information on services available and how to access them is vital in empowering people with visual impairment. Improvements are needed on a number of levels. There is a need to broaden awareness within the population of what services are available and how they can be accessed. More precise information regarding services needs to be provided at 'first points of entry' such as eye clinics, GP surgeries and libraries. This information should be collected jointly across sectors to produce a comprehensive 'directory' for each area. Information on other services provided by local authorities and their partners should also be provided in formats accessible to people with visual impairment, in keeping with the requirements of the Disability Discrimination Act.
Referral, assessment and rehabilitation planning.
Ensuring a swift and clear route from initial referral through specialist assessment to provision of appropriate rehabilitative support is vitally important for people with visual impairment. Each interaction needs to be sensitive to the needs of the service user, in order to ensure that users obtain the right services without having to experience the trauma of prolonged assessment interviews or delays between different stages of the process.
Currently, there is a significant variation both in how people
with an identified visual impairment get a specialist assessment and how the
assessment is carried out.
Differences include whether or not the initial and specialist assessments are
carried out face to face, and in a location selected by the user; time taken to
complete stages of the assessment; and how successfully the full range of
potentially eligible users are identified and helped through the assessment
process. Ensuring appropriate and timely referrals to specialist visual
impairment services from health agencies, or other parts of the local authority,
is crucial, as is obtaining a general reduction in the time taken between
initial referrals and the signing off of a rehabilitation support package.
Rehabilitation.
Despite a general increase in staffing and other resources within visual impairment services over recent years, deficiencies in staffing levels and in the availability of professional development remain. This means that available services provision is variable across Wales, and in a number of cases is inadequate. There are a number of suggested reasons for this, including problems with recruitment and retention, and inadequate levels of continual professional development. The detrimental effects in quality of rehabilitation services available are accompanied by weaknesses in the ongoing evaluation of provision and revision of rehabilitation plans where necessary.
Children and young people.
Addressing the needs of children with visual impairment poses
specific challenges.
Often these children are not referred to social services at all. Those that do
enter social services through specialist children's teams often do not receive a
full specialist visual impairment assessment, diminishing their prospects of
receiving appropriate and rounded support and enjoying maximum independence.
Only 7 Welsh councils have a policy for working with young people with visual
impairment. Visual impairment in children is often not picked up, or can be
afforded a lower priority, particularly when one of a number of needs presented
by an individual user, with detrimental effects on the overall quality of
service and the life chances of the individual.
Less than half the authorities in Wales report having regular formal interaction between staff in social services and education to consider the needs of young visually impaired people. Formalised links between social services, education and other services within local authorities and the health sector are needed if there is to be better diagnosis of young people's needs in these areas, and the provision of appropriate services.
The way forward.
This report and its implementation represent important first steps in our aim of achieving consistently high standards and continuous improvements in visual impairment services across Wales. Regular evaluation of the impact brought by the study on the quality of visual impairment services will be vital, and the benchmarking group propose regular 'progress' meetings in the future, providing a forum for sharing progress and exchanging experience and practice.
1. Source: Welsh Health Survey 1998. ^
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Visual Impairment - an Introduction to the Service and Related Issues.]