1. 1 Access Matters Making healthcare environments accessible Making Accessibility a Reality Ceri Jackson Joanne Lawson

2. 2 Why Accessible Environments Welcoming Safe Responsive to people's needs Intuitive to use Independence Navigation

3. 3 Sight Loss - The Facts There are 106,000 people in Wales with sight loss There are 2 million people in the UK with sight loss The incidence of sight loss will double by 2050 1 in 2 people over 90 are living with sight loss 1 in 9 people over 60 are living with sight loss 1 in 3 people with dementia have sight loss 1 in 6 people in the UK have a hearing loss There are approximately 356,000 in the UK with a combined visual and hearing impairment

4. 4 About Sight Loss Leading causes of sight loss - Refractive Error, Age Related Macular Degeneration, Cataract, Glaucoma and Diabetic Retinopathy There are 1,800 children in Wales with sight loss - up to 50 per cent have another disability People with a learning disability are 10 times more likely to have serious sight loss Over one third of people with sight loss are living with depression Half of all sight loss is avoidable © RNIB Cymru Registered charity number / Rhif elusen gofrestredig 226227

5. The Financial Cost of Sight Loss The direct cost of sight loss to Wales is £124 million. Direct costs of sight loss are based on NHS expenditure on sight loss, such as inpatient procedures, outpatient appointments and ongoing treatment The indirect cost of sight loss is estimated to be £263.2 million annually. Indirect costs of sight loss include the informal provision of care by family and friends and other indirect costs such as reduced rates of employment and the cost of specialist equipment 5

6. The Human Cost of Sight Loss In Wales it is estimated that there are 48,546 falls a year amongst older people that are directly attributable to sight loss. Of these falls, 485 are estimated to be severe falls that require hospital admission Legood et al (2002) suggest that people with sight loss are 1.7 times more likely to have a fall and 1.9 times more likely to have multiple falls. They also suggest that the odds of a hip fracture are between 1.3 and 1.9 times greater for those with sight loss 6

7. Costs of Episodes related to falls and sight loss Age Group18 - 5960-74>75Total Fall Type£million Admitted4.893.8114.0322.73 A & E0.260.190.691.14 Day Cases0.030.020.080.14 Ambulance0.230.190.671.09 Total5.414.2115.4825.10 Source: Access Economics, 2009 7

8. The Jones Court Journey We carried out a consultation exercise with service users, members and partners - in all, we consulted 1,000 people We gathered their feedback to inform our decisions We were in the business of changing hearts and minds We evaluated the results The project team encountered lots of challenges but the end result was worth it. As one of our members said: “ It is such a lovely and welcoming atmosphere - I can’t wait to come in and attend meetings” 8

9. Natural age related changes Decline in visual acuity Decline in colour vision Greater glare sensitivity Decline in dark/light adaptation Poorer depth perception Poor recognition of objects, difficulties judging size and shape Reduced peripheral vision

10. Cataracts Vision begins to blur Key features start to merge Detail is severely reduced Bright light extremely difficult Poor colour definition

11. Diabetic Retinopathy Patchy vision Lack of sharpness of visual field Scene merges so almost impossible to see direction of travel

12. Macular Degeneration Loss of central vision Some remaining peripheral vision Objects can change shape Straight lines bend Colours start to fade Bright light and glare difficult Problems adjusting to change in light

13. Glaucoma Tunnel Vision Bright light is painful and reduces vision Getting around is difficult May see things at eye level but miss obstacles below this

14. The importance of sight 75% of information about our environment comes to us via our eyes; 13% from our hearing; 12% from other senses.

15. The built environment- a confusing place

19. Future proofing Lighting Lux - promote safe levels of lighting Even spread of light Avoid dark spots and shadows Control glare Control light-variety of adjustable lighting Transitional lighting Sun downing and night time lighting Homely, warm and welcoming Critical to control natural lighting

20. Lighting

21. Fashion advice or lighting?

22. Future proofing Colour and tonal and contrast Gather information about space itself, identify key features, hazards and aids navigation Not just about colour Apply to all critical surfaces High risk areas

23. Good colour and tonal contrast does not mean lots of bold colours Colour, tonal and contrast

24. Light reflectance values (LRV) Luminance is calculated on a scale 0 – 100 0 is a perfect black, 100 is a perfect white

25. Glaucoma with colour deficiency

26. Cataracts and colour deficiency

27. Colour and tonal contrast

30. Future proofing Surface finishes Matt surfaces Avoid high gloss Minimal patterns Homely Welcoming

31. Surface finishes

32. Future proofing Way finding and signage Promotes orientation Supports mobility Multi sensory approach is crucial Visual and sensory queues Objects of reference Signage

33. Way finding and signage

34. Future proofing Visual Clutter Minimise clutter and confusion Keep things simple, clear and concise

35. Visual clutter

36. Recommendations Inclusive design principles Identify champions in structures throughout the process Awareness Training Identify opportunities in capital and refurbishment programmes Co-production and engagement with patients Partnership and awareness work with inspection bodies, patients experience teams, etc. Get it right first time! 36

37. Thank you for listening Questions? Ceri jackson Ceri.jackson@rnib.org.uk Joanne Lawson Joanne.lawson@rnib.org.uk 37