Parvaneh Rabiee, Kate Baxter, Gillian Parker and Sylvia Bernard RNIB Research Day 2014: Rehabilitation and social care RNIB, 105 Judd Street, London 20 October 2014

 Background and the rationale for the project  Aims and methods  The key findings  Conclusions  Implications for policy and practice

 A rise in the number of people living longer with long-term conditions  Sight loss is most prevalent among older people  Increasing pressure on health and social care services  Preventive and rehabilitation services are a high policy priority for all care settings  Reduce the number of people entering the care system  Reduce needs for on-going support

 Growing interest in rehabilitation not a new idea:  1997: The Audit Commission  2000 onwards: Significant investment in intermediate care and reablement services  2010: DH guidance on eligibility criteria for adult social care - endorsed by:  UK Vision Strategy Advisory Group 2013  Vision 2020 UK 2013  ADASS guidance 2013  2013: RNIB - ‘Facing Blindness Alone’ campaign  2014: Recent DH Care Act guidance

 Much of the existing research has focused on low vision services – not clear  What community-based rehab services are currently doing to support people with VI  What impact they have on people with VI  What a model of ‘good practice’ might look like  The study funded by Thomas Pocklington Trust is the first step towards a future full evaluation study of vision rehabilitation services

 To provide an overview of the evidence base for community-based vision rehab interventions:  People aged 18 and over  Rehab interventions funded by LAs in England  The study involved 4 main research elements:  A review of literature  Scoping workshops with people with VI and key professionals  A national survey  Case studies

No secure evidence around effectiveness, costs and different models of community-based vision rehab services – however some strong messages for:  The potential for vision rehab to have a positive impact on daily activities and depression  High prevalence of depression in people with VI and increased need for emotional support  Vision rehab interventions mostly target physical/functional rather than social and emotional issues  The cost effectiveness of group-based self- management programmes

 60% screened by professional with specialist vision rehab skills  95% assessed by professional with specialist vision rehab skills  25% required FACS assessments  66% reported a waiting list  Average waiting time 8-10 weeks

 Survey data on budgets poorly reported  Annual budgets £13,000 to £800,000  Average budget £221,000  Annual caseloads 16 to 2000  Additional data from three case studies  Annual budgets £238,000 to £336,000  Annual caseloads 282 to 3322

 Who provides the service  A and B: LA in-house  C: Contracted out service  Team delivering vision rehab  A: Sensory Needs  B and C: Visual Impairment  Manager specialism  A: Social Work  B and C: Visual Impairment  Current waiting time:  A: up to 6 months  B: up to 2 months  C: up to 1 month

 35-40% of time spent on admin duties – travelling time varied  Differences in the way services operated  Sites A & B restricted activities to one-to-one intervention - Site C offered a range of group-based activities  Only one site (C) measured outcome using an evaluation tool  Limited staff training & networking opportunities - more opportunities in site C

 Access to specialist knowledge and skills  Concerns about the loss of specialist input within the team  Early access to vision rehab interventions  Late referrals risk care needs intensifying and clients losing motivation  A tendency among health professionals to see vision rehab as the last resort  The characteristics of people who use vision rehab services

 A long gap between diagnosis and referral - in particular those with degenerative conditions  Rehab goals tailored around individual needs  Support could continue as long as needed - But...  Waiting list to get additional training - Site B  Time constraints - Site C  Progress monitored informally & no follow-up contacts

 Boosted confidence, improved independence. Increased motivation  People felt safer  Greatest benefits related to mobility training, independent living skills and supply of aids, adaptation and equipment.  Group-based activities offer great opportunities to socialise and learn from peers’ experiences  Positive impacts on families

 Information not always forthcoming and timely  Concerns about future needs  Help often offered when it is too late/when people ‘have to have it’  Emotional needs not met effectively  Social activities most often geared towards older people

 Staff with specialist knowledge and skills  High quality assessment  Personalised support  Offering a wide range of support  Flexibility to adapt to users’ abilities  Timely intervention  Shared vision among all relevant health and social care staff  Regular follow-up visits  Easy access to information

 Potential for vision rehab to have a positive impact on the quality of life for people with VI  A wide variation of vision rehab provision – measuring outcomes not a common practice  Restricting access on the basis of FACS assessment  Negative impacts of financial cuts  Lack of recognition of specialist vision rehab skills  Group-based activities effective but limited  Main focus is on the physical aspects of life

 All LAs should follow the recommended practice on FACS eligibility criteria – timely intervention  Raising the profile of specialist vision rehabilitation skills  Safeguarding specialist assessments  Taking account of individual priorities  Improved staff training and networking opportunities  Greater focus on group-based activities