The costs avoided through effective vision rehabilitation services Mike Bell   My name is Josh Feehan I am the Early intervention and rehabilitation project manager for RNIB and presenting with me today is Sue Fritsch My name is Sue Fritsch and I am the Operations and Development Manager for Sight for Surrey’s Sensory Service and reasons for involvement in this project Sue slides 1,4,8 & 9

Why vision rehabilitation? Vision rehabilitation provides crucial training and advice to people experiencing sight loss, including support to help them live in their home safely and negotiate the many obstacles and risks in the external environment. All councils in England provide this service. Evidence shows that many blind and partially sighted people are failing to receive vital vision rehabilitation support. Council budgets have been reduced, waiting times and waiting lists have grown and specialist rehab skills have been undervalued.

See, Plan and Provide campaign RNIB launched the See, Plan and Provide campaign to call for improved access to vision rehabilitation assessments and support: See: everyone with a visual impairment must receive a specialist face to face assessment. Plan: everyone must have a plan in place, identifying the outcome of their assessment. The first two steps must take place within 28 days of first contact with the local authority. Provide: any agreed vision rehabilitation support must start within 12 weeks of the person’s initial contact with the local authority.

Engaging local authorities Through See, Plan and Provide we have engaged more than 70 local authorities across England to: Protect budgets Raise awareness Share good practice Tackle long waiting lists/times Promote professional skills

So why cost avoidance research? Limited evidence base for the widely held view that vision rehab avoids long term costs Critical need to educate commissioners of services on the financial impacts Key additional tool alongside See, Plan and Provide and the 10 principles of good practice

Cost avoidance – the approach Who are OPM? (Office for Public Management) What is cost avoidance? Underpinned by sound economic analysis principles including HM Treasury Guidelines The work is support by assumptions drawn from primary and secondary research Case study bottom-up approach to identifying costs and outcomes

Case Study site – Sight for Surrey Established in 1922 Mission to support service users to live full and independent lives Commissioned by LA to provide all sensory services in Surrey Team structure Support around 700 service users every year

Methodology: Overview Map the vision rehab process Explored vision rehab service models Documented case study model Calculate costs Interviewed professionals Reviewed data from case study site Identify outcomes Interviewed professionals & service users Assigned indicators Assign £ values to outcomes Rapid literature review Identified proxy measures

Methodology: Calculating costs Who does what? Time it takes? How often? • How much resource to provide vision rehab service? How these costs break down • Different cost scenarios • Minimum, maximum and midpoint costs

Methodology: valuing outcomes Assign indicator to each outcome Identify a financial value or proxy Identify proportion of service users who experience outcome Multiply proxy figures by proportions to calculate value of each outcome Add totals

Key findings – outcomes identified Service user outcomes: Functional independence Personal safety Social participation Emotional well-being

Methodology: Identifying outcomes “I stop and talk to people now, lots of people want to help when they see the stick and I don’t feel embarrassed to talk to them. My case worker was invaluable, she broke down my embarrassment.” – Service user

Key findings: Costs avoided / outcome values Total Per referral Overall £3,423,844 £4,849 In health & social care system £3,168,023. £4,487 For service user, family / carers £255,823. £362 The total cost of Sight for Surrey’s service was calculated at just over £900,000; equivalent to £1,300 per referral.

Examples of outcome and indicator area 2. Impact area 3. Outcome 4. Indicator 5. Financial proxy for indicator 1. Increased functional independence 1a. Improved ability to travel (alone) outside of the house in local area Reduced reliance on family members/carers for transport Community transport cost 2. Increased personal safety 2a. Less likely to be injured from accidents in and outside the home and require ambulance Reduced no. of ambulance calls/trips Ambulance costs 3. Improved emotional state / wellbeing 3a. Increased level of acceptance of vision impairment condition Reduced use of mental health services/ counsellors for stress, anxiety or depression Mental health service costs 4. Increased social interaction / decrease in social isolation 4a. Service user has increased contact with people in the community, networks and friends Increased no. of contacts with family, friends, networks and community members 5. Reduced anxiety about service user 5a. Increased confidence that service user has an additional source of support for vision impairment and decreased feelings of worry/anxiety about service use Reduced need for accessing mental health services due to stress, anxiety or depression

Next steps with research? Supporting See, Plan and Provide by: Raising awareness within the sight loss sector; Engaging local authority commissioners and directors on financial impacts of good vision rehabilitation services; Promoting the need for good evidence and research to support decision-making. We’re asking rehabilitation service managers and rehab workers to: use this evidence to protect their service; explore if outcomes and costs for their own service can be mapped against this model. We’re asking service commissioners to: protect existing vision rehabilitation services from further cuts; consider how they can provide good quality services for blind and partially sighted people which meet RNIB’s ‘See, Plan and Provide’ criteria and are informed by the ‘10 Principles of Good Practice in Vision Rehabilitation’.

RNIB Early Intervention and Rehabilitation Project ‘10 Principles of Good Practice in Vision Rehabilitation’ Best practice case studies Workforce survey and findings Apprenticeship standard and route CPD for the rehabilitation workers Raising awareness with health and social care professionals regarding vision rehabilitation

Contacts / links Link to See, Plan and Provide campaign pages on RNIB website: http://www.rnib.org.uk/campaigning-current-campaigns-care-and-support/see-plan-provide This page includes details of the cost avoidance research, our ‘See, Plan and Provide’ reports, the ‘10 principles of good practice in vision rehabilitation’ and lots of other useful data and documents.