Why is it an issue?
Sensory impairment can have a significant impact upon the life of an individual. RNIB (2010) predict that there are approximately 2 million people in the UK with sight loss that affects their daily life. Sensory Impairment places strain upon the health, social and the economic needs of both individuals and society in general (Servat et. al 2011). RNIB (2010) suggest that the annual cost of sight loss in the UK amounted to a minimum of £6.5 billion in direct health care and indirect costs, such as reduced employment.
Visual impairment disproportionately affects people within a higher age range. RNIB (2010) predict that the incidence of sight loss will increase in line with an increasing aging population and with an increase in underlying causes of sight loss, such as obesity and diabetes.
Early intervention has been identified as a key element in preventing vision loss at a local and international level (Vision 2020, 2010). For those people with vision loss, research has highlighted the need for accessible information, rehabilitation services and equipment, which can maximise independence. These services are critical in ensuring that people with vision loss are able to interact with the built environment, maintain physical and physiological health, and participate in their community (McLaughlan, 2008).
Deafness and hearing loss in general is an issue because it can be very disabling. People with significant hearing loss can certainly feel and often are very isolated because communication becomes increasingly difficult. Tensions within households rise and problems with neighbours increase eg volume of TV leading to complaints and sometimes legal action.
Action on Hearing Loss (RNID) report that “79% of people first receiving hearing aids are given no information regarding services and information that might be useful “ (2008). This is about ‘point of diagnosis’ intervention.
The report also identifies lack of information about the aids, maintenance and follow up. The survey found only 25% of audiology depts. Had a procedure in place to review needs of patients.
What’s the local picture and how do we compare?
How do we compare?
What do things look like locally?
- Wakefield has a population of 1006 people registered severely sight impaired (Blind) and 1367 people registered sight impaired (partially sighted).
- National figures suggest that approximately 29% of all persons registered blind will have an additional disability that may compound their lifestyle. 1.3% will suffer from a mental health problem and 17.6% will have another physical disability. 2.4% will also have a learning disability (Ophthalmology HNA, 2010).
- Comparative data is not available for Wakefield in 2008 (many fields are not available), but there is such data for 2006. Wakefield reports exceptionally low across all additional disability categories in comparison to other Yorkshire & Humber districts. This may be a reporting issue, rather than a genuine difference in associated need (Ophthalmology HNA, 2010).
- In comparison to other areas, Wakefield District does is not estimated (by the NEHEM modeller) to have a higher level of ophthalmological need than that of other SHA organisations. While prevalence estimates are relatively close between neighbouring areas, Wakefield is consistently regarded as having a lower level of need on each of the NEHEM outputs. While some of this difference can be perhaps attributed to having a comparatively smaller Black and Minority Ethnic (BME) population, the reliability of the modeller will always be subject to questioning (Ophthalmology HNA, 2010).
- Unmet need in visual problems (based on the definition found in the lifestyle survey) increases with age, although the percentages in men of all ages (except post-75) are higher. While there is not sufficient evidence to suggest why this may be the case, there is evidence at a national level that men are often reluctant to enter into treatment – particularly where preventative treatment is concerned. That need is higher in Wakefield North, Wakefield East and Knottingley. (Lifestyle Survey, 2009; Ophthalmology HNA, 2010).
- Wakefield has 270 people registered as deaf and 710 as hard of hearing in 2004, but the RNID also states that figures from the registers should be treated with caution due to significant under-reporting (Deaf Community HNA, 2010).
- Currently 1632 people on the register: 337 deaf, 1108 hard of hearing and 87 deafblind.
- These figures are notoriously inaccurate because of under reporting and the absence of the kind of recording and informing framework available for Blind and Partially sighted persons.
- Recent HNAs of the deaf community have suggested that people in that community felt their health was good and did not feel any less healthy than their hearing counterparts – although this is a self-reported and subjective measure (Deaf Community HNA, 2010).
What’s the trend and what can we predict?
- Low vision, cataracts, macular degeneration and glaucoma are all predicted to rise – substantially so as the population ages. Numbers are available in the linked document (Ophthalmology HNA, 2010).
- That trend is also likely in the hard of hearing, although accurately modelled numbers are not available.
- The majority of people with hearing loss are older people many of whom may already be struggling with daily living/personal care tasks so early intervention can be a key factor in reducing subsequent health and social care dependency. Numbers are increasing.
- The numbers of people with dual sensory impairment / deafblindness must also increase with an ageing population. The DoH definition clearly describes the functional difficulties arising. We probably do not acknowledge the significant consequences of deafblindness on the lives of people.
What are we doing and what can be done differently?
- The employment of two Eye Clinic Liaison Officers (funded the Local Authority, PCT and Mid Yorks Trust) provides a bridge between Health and Social Care. The role of this post is to provide emotional support, early intervention, information and advice and onward referral.
- Re-launch of Low Vision Leaflet to facilitate timely referral to social care services for people experiencing difficulty in their daily life because of sight loss.
- The launch of the Primary Eyecare Acute Referral Scheme (PEARS) enables prompt referral to an optician in the community for people who are experiencing a sudden eye problem. This enables early identification and treatment, to reduce sight loss.
- The Diabetic Retinopathy Screening programme provides a systematic process for early identification and treatment of retinopathy, to significantly reduce sight loss caused by Diabetes.
- Joint work between PCT, Third Sector, and Wakefield MDC to raise awareness of the impact of visual impairment and general health. For example – Falls Awareness and Visual Impairment events.
- Ensuring that people with a visual impairment are able to access healthcare services. Use of the RNIB ‘Losing Patients’ form to enable people with a visual impairment to request appointment information provided in an accessible format.
- Raising awareness and promotion of inter-agency working to recognise the impact of sensory impairment and additional disabilities. Wakefield MDC funded ‘Ocular Health and Stroke’ course for Local Authority and Health Care professionals. Provided by the Stroke Association and developed in conjunction with Wakefield MDC.
- Sensory Impairment Team provides assessment of people with sight loss and individualised programmes of rehabilitation training to maximise independence. This includes Orientation and Mobility Training (Long Cane Training), Daily Living Skills Training (Food preparation, medication management, personal care).
- Communication Training (IT training, Braille, Moon etc. Eccentric Viewing and support to use Magnifiers.). Self-Directed Support provides a mechanism for people who meet Fair Access to Care Services criteria to receive a budget to enable their outcomes to be met creatively and individually.
- Third Sector partnerships ensure access to a range of services such as Guide Dogs Association, Action for Blind, Wakefield District Sight Aid, Macular Disease Society.
- Provision of Assistive Technology to people with a sensory impairment to maximise independence. For example, Telecare.
- To ensure services continue to meet the needs of people with a sight loss, Family Services support a Visual Impairment Forum who critique the services provided by the Visual Impairment Section of the Sensory Impairment Team.
- Review the processes at audiology and test out the Action on Hearing report – evidence based research.
- Encourage social care assessments to question hearing aid management and include maintenance as part of a care plan.
- Continue to raise awareness and look to continue interagency work.
- Make best use of local 3rd sector and ideas from further afield such as SENSE and Action on Hearing.
- Take the service into the community.