1. The costs avoided through effective vision rehabilitation services
Mike Bell
Welcome to our presentation where we will be discussing an exciting new piece of research on the costs avoided through effective vision rehabilitation services
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

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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
An indicator is a measurable change occurring for an individual if an outcome occurs for them.
The proxy figure is an accepted market value of an item or service that is representative of the change occurring on the indicator in a set period of time.
These proportions are drawn from the available evidence or modelled using a ‘percentile approach’. Each proportion is then applied to identify the number of beneficiaries.
The proxies from step 2 are multiplied by the numbers of individuals in step 3 to calculate a pound value representing the costs avoided, saved or deferred by the outcome.
The values of each outcome are added together to calculate the total value of costs avoided, deferred or saved due to the Sight for Surrey vision rehabilitation service.

11. Key findings – outcomes identified
Service user outcomes:
Functional independence
Personal safety
Social participation
Emotional well-being
Outcomes are the changes, benefits, learning or other effects that happen as a result of a project or organisation’s work.

12. 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

13. 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.

14. 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

15. 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’.

16. 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

17. Contacts / links
Link to See, Plan and Provide campaign pages on RNIB website: 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.