What Vision

1
What Vision?

• Mary Bairstow
• Low Vision Steering Group
• July 4th 2007

2

• What a history (a reminder)
• What standards?
• Whats my opinion?
• So whats the local society response ?

3
Low Vision Services Implementation

• Late 1990s
• More and better services
• Low vision report
• Sets standards and suggests Low Vision Services
  Committees
• Nalsvi endorsed

• Late 1990s
• More and better services
• Low vision report
• Sets standards and suggests lvscs as a means to
  change

4
It should be easy

• Get everyone around the table
• Identify what needs to be done
• Make plans about how to do it
• Work with local commissioners
• (PCTs , social care)
• Monitor

5
2000 - 2007

• 78 LVSCs
• (Blackburn with Darwen newest)
• Emperors new clothes or visionary groups ?

6

• A question of independence (Nov 2006)
• RNIB and AMD Alliance UK funded McLaughlan, B.,
  Lightstone, A. and Winyard, S

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Not relevant?

• The majority (91) could see the shapes of
  furniture in a room (or better)
• Network 1000 2006
• 71 cent of people said they used magnifiers for
  reading
• Network 1000 2006
• 73 said that they used better lighting for
  reading tasks
• Network 1000 2006

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But what vision

• 1/4 of service providers admit their services
  less than satisfactory or unsatisfactory
• AMD Alliance 2006
• and
• Service users do not know what they can expect
  from service providers
• Low Vision Project National Evaluation Report 2005

9
Accountability

• 40 - funders no accountability
• 16 require yearly audits
• 14 ask for accounts
• 11 variety of different ways

AMD Alliance 2006
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Setting Standards

• Some LVSCs lack clarity about their purpose
  (despite the clear remit given in the 1999
  Report)
• Low Vision Project National Evaluation Report
  2005

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Seeking a solution?

• How you would you recognise a good service?

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A consensus

• LV recommendations for future service delivery
• Working Group
• 19 members
• 2 users
• Nalsvi representation (Ian Atrill)
• ADSS, Rehab., Vol Orgs

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Status

• Voluntary sector recommendations
• Endorsements - Loads
• Foreword - Frank Dobson

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1999 standards

• Who, where, what, when, continued support and
  monitoring services..
• Not clinical parameters
• Close to home
• Eye exam. to certification to vision
  enhancement training...
• Within 6 weeks
• Returning as required
• Monitored

15
Setting a new Standard

• Working party set up 2006
• 9 members
• Included one rehabilitation worker
• 4 Optometrists
• 1 Dispensing Optician
• 1 Ophthalmologist
• 1 Orthoptist
• 1 Department of Health
• Consultation 2006. Launched Jan 2007

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Status

• Recommended by the DH
• Endorsed by LVSG
• May be reviewed

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The standards

• 6 Headings
• Design Principles
• Referral, assessment and service
• Information
• Service improvement, monitoring and evaluation of
  the service
• Training
• Communication

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Design Principles

• Multi-agency approach that coordinates with other
  services (but its an efficient methodology!)
• User centred - involving participation
• Not dependent on registration
• Evidence based - conforms and contributes to
  governance
• Attends to timescales -not defined -need to
  identify
• Review of low vision needs

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Referral

• Any care or health professional
• Self referral
• Reviews included
• Warns against strict entrance criteria
• Notes importance of medical diagnosis
• Recording dissent - particularly if against a
  persons best interest

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Low Vision AssessmentThe essentials

• Eye health - done,doing or included
• Functional vision assessment
• Appendices to describe

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Desirables

• Prescription of device
• Supply and loan - protocols agreed
• Lighting, contrast, filters
• Other aids
• Training and therapy
• Links to broader rehabilitation
• A review of benefits, welfare rights,
  concessions, support groups

22
Information

• Appropriate formats
• Enable informed decisions
• Communication - colleagues with consent
• All professionals should use a health/care record

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Local commissioners - will wish

• Service Improvement, monitoring and evaluation of
  the service
• Modernisation techniques
• Measures - numbers referred/ treated
• - demographics
• -
  inter-professional communications
• - evaluation
  data
• Service user involvement
• Annual report by commissioners - working
  towards !

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Training

• Suitably trained as part of a local protocol
• Accreditation - initial
• - ongoing
• - reflect lessons learnt
• Multi-disciplinary
• CRB checks noted

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Appendices

• Already noted 1 and 2 - eye health and functional
  assessment
• Appendix 3 - Personnel
• Includes carers but forgets teachers!
• Notes on supply
• Appendix 4 equipment
• Appendix 5 benefits
• Further reading

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User led changes?

• LV Consensus 99
• Devices should be loaned
• Specific times (6w)

• DH LV 07
• Loan/supply agreed locally
• Agreed timetables (though 10 days for contact)

27
Whats new?

• Emphasis on booking of appointments
• Reference to service being refused
• Notes on CRB checks
• Single contact point (though this is mentioned as
  an LVSC aim)
• Directions for commissioners

28
Whats been lost?

• Notion of implementation or governance ( LVSCs )
• Sense of the essential
• Some specifics - Transport
• -
  Issues of geography

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So can it work

• Huge variation in activity and outcomes
• Marys factors for success
• A Vision
• Self belief
• Strong lead - good chair
• The right membership
• Service user strategy
• Commissioning involvement
• Reporting routes

30
Local Society support?

• Link to or attend LVSC
• Give advice - pass on expertise
• Support user involvement
• Ensure PCT approaches acknowledge multi-agency
  (LVSC) model

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Keeping up to date

• Link into the national network
• l.beaumont_at_vision2020uk.org.uk

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Thank You for Listening

• You can find me at
• M.Bairstow_at_vision2020uk.org.uk
• Website lowvision.org.uk