Barnet Vision Strategy
2013 – 2016
Contents
EXECUTIVE Summary
1. INTRODUCTION 1
Evidence base
2. Main diagnoses of Blindness 7
3. Socio-economic factors 9
4. Lifestyle Factors 11
5. Additional Factors Affecting the Health and Wellbeing of People with Sight Loss 14
6. Health and wellbeing problems caused by Visual Impairment 16
mapping the sector
7. Barnet’s Ideal Sight Loss Diagnosis and Rehabilitation pathway 18
8. Local Services and Provisions: The journey from sight, to vision impairment and towards independence in Barnet. 20
9. Wider Avenues of Support 32
conclusions
10. Conclusion 35
11. Service Development Priorities 36
12. The Service User Perspective 40
Appendix
1. Opticians in Barnet
2. Barnet Vision Strategy Group Members
3. Ideal Sight Loss Pathway for Children and Young People
Executive Summary
The three main challenges facing Barnet in its provision of low vision services are:
1. The population of visually impaired people in Barnet is expected to increase from 9,290 to 11,910 by 2020.[1]
2. In 2010-11 £15.15 million was spent by Barnet Primary Health Care Trust on ‘problems of vision’.[2] With an expected increase in visual impairment by 2020, this could rise significantly over the next 7 years.
- 50% of this sight loss, and expenditure, is avoidable through the modification of lifestyle and increased awareness of sight loss.
Reducing unnecessary sight loss can potentially lead to cost savings within local areas as well as helping to maintain good health, wellbeing and independence for individuals through the modification of lifestyle and increased awareness of visual impairment.
While there is some great work happening to support those with sight loss in Barnet there are also some critical gaps. The most critical points in the provision of low vision services are to:
· Health and Wellbeing: Embed the Vision Strategy into the Health and Wellbeing framework, and achieve a user led partnership approach to the planning, delivery and evaluation of eye health and sight loss support services (Action Plan 1)
· Prevention: Maximise the uptake of eye examinations and raise awareness of eye health to ensure that avoidable sight loss is prevented wherever possible (Action Plan 2)
· Joined up data: Ensure that comprehensive cross sector data on sight loss and local demographics is collected and shared to inform resource allocation across Public Health, NHS, Optometry, Social Care and Voluntary organisations (Action Plan 3)
· Joined up services: Ensure that an effective and efficient service provision is available, resulting in a clear pathway for people experiencing sight loss from diagnosis through to independent living. This will include optometrists, GPs, eye clinics, social care teams and voluntary services (Action Plan 4)
· Social inclusion and independence: Ensure that people with sight loss have good access to key local services - information, transport, leisure, employment, education and welfare rights to obtain and maintain independence and not experience social exclusion, inequality or isolation (Action Plan 5)
· Children’s services: Develop and embed into the main vision strategy considerations for children and young people, including evidence of current and future need, sight loss pathway, arrangements for transition to adult services and an action plan to address gaps and need (Action Plan 6)
· Visually Impaired people with complex needs: Ensure that the needs of people with visual impairment as a secondary presenting condition are recognised. Visual impairment is often overlooked in those with, for instance, Dementia, Parkinson’s, Learning Disabilities, etc. (Action Plan 7)
· Involve local People in Sight Loss Priorities: Involve people with sight loss in defining priorities and ask them for feedback on our work (Action Plan 8)
The main priorities identified in Barnet, through consultation with service users and providers, to start addressing these key points are:
1. Inclusion of the Barnet Vision Strategy in the Joint Strategic Needs Assessment (JSNA), and ensure that it is recognised by the CCG and Health & Wellbeing Board
2. Have an ECLO: to provide early and on-going emotional support.
3. Awareness: Raising:
a. Eye health ambassador to give talks to hard to reach groups, in shopping centres, schools & workplaces
b. Mount events to coincide with National Eye Health Week and World Sight Day– NB The PSI Partnership Board have offered to support this.
c. Investigate other notable ‘vision’ days as opportunities to mount awareness events (eg. Glaucoma Day, 6 March)
d. Participate in Mencap’s Happy Healthy Funday (Sept 2013)
4. Produce a Sight Loss Pathway Contact Folder detailing all stages, stakeholders, services and support organisations at each stage of the pathway (NB Section 8 of the Vision Strategy could be used to frame this). The folder should be designed to hold a separate, easily up-datable, contact list detailing relevant services and organisations at each stage of the Sight Loss Pathway.
· Make this Sight Loss Pathway Contact Folder available through all eye clinics, optometrists, GPs, voluntary orgs, etc as a resource for service users and providers alike.
· Each agency to cascade the Folder to at least 2 others
· Ensure the Folder is available in accessible formats
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1. Introduction
Barnet Vision Strategy is a document that provides a single portal for the planning, commissioning, delivering and evaluating of services for eye health and sight loss support in the community. This strategy outlines the present service landscape, and considers how it will need to develop to take into account current socio-political changes. The document also identifies gaps in service provision, as they presently stand, and will set out recommendations for Barnet’s future sight loss priorities.
Collaboration was central to the development of Barnet’s Vision Strategy; participating partners included, local health and social care services, as well as the voluntary sector, patient/service user groups and advisory agencies. Accompanying this strategy is an action plan that outlines how local partners will work together to put visually impaired people at the heart of a seamless, cost-effective service.
Barnet’s Vision Strategy forms part of the wider UK Vision Strategy, which seeks to achieve the following three aims:
1. Everyone in the UK looks after their eyes and their sight.
Prevention (importance of sight tests/early detection, groups at higher risk of sight loss such as BME groups, people with learning disability, links with other health issues)
2. Everyone with an eye condition receives timely treatment and, if permanent sight loss occurs, early and appropriate services of support is available and accessible to all:
Provision (primary and secondary care, rehabilitation and low vision support)
3. A society in which people with sight loss can fully participate:
Participation (education, employment, transport, leisure, housing and so forth to allow greater opportunity for independent living)
The aims of the UK vision strategy reflect national recognition that the increasing instances of sight loss will have a considerable impact on local communities as they seek to address the personal and economic consequences of sight loss.
Economically, the impact of sight loss is considerable, with estimations that sight loss cost the UK economy £22 billion in 2008. These costs are set to rise as the number of visually impaired people living in the UK is expected to double, from 2 million to 4 million by 2050.
On a personal level, the development of a visual impairment can be a deeply traumatic experience; it can lead to the loss of one’s employment, hobbies and leisure activities, routines need to be adapted, and everyday tasks become harder to achieve without outside help. However with the right support the costs associated with visual impairment can be eased on a personal, social and economic level.
‘I could not believe it. It was like somebody had ripped the rug from underneath my feet. I was in no man’s land’.[3]
The Barnet Vision Strategy Implementation Group is committed to cutting the number of people developing sight loss and alleviating the personal impact of visual impairment in Barnet. This will be achieved through the development of a joined up, cost effective service, which will put those experiencing temporary or permanent sight loss at the heart of service delivery.
1.2. Costs, trends, and the prevalence of visual impairment in Barnet
In 2011 there were 1835[4] people registered as blind or partially sighted in Barnet.
However, for a number of reasons, only 1 out of every 5½ people with an impairment affecting their day-to-day life are registered as blind or partially sighted.[5] Therefore, a much more accurate estimate would be about 10,092 blind or partially sighted people living in Barnet.
Clearly, a more comprehensive registration process would help service providers plan their services more effectively, it would also help empower people living with a visual impairment to push for better low vision services by illustrating their widespread need in Barnet.
In 2010-11 £15.15 million was spent by Barnet Primary Health Care Trust on ‘problems of vision’.[6]
[NB: this refers to the cost of low vision health services such as hospital admission for cataract surgery or glaucoma treatment. This does not include the associated costs to the NHS for accidents that arise from visual impairment, or the cost of support provided by social care services.]
There are 356,400 people living in Barnet. [7]
· 25% (90,100 people) are aged 18 and under
· 57% (123,600 people) are aged 19-59
· 11.4% (40,600 people) are aged 60-74
· 6.6% (23,700 people) are aged 75+ (of which 2,900 are over 90)
· The ratio of men to women, in the borough, aged 50+ is 44:56
· 35% are from black or ethnic minority backgrounds
1.3. Future Trends in Visual Impairment and Predicted Costs
Currently, there are 1,835 people registered as living in Barnet with a visual impairment. However, for numerous reasons, the RNIB estimate a more accurate number of people living with a visual impairment in Barnet is 9,290. The estimated number of people living with sight loss is a measure of all of those people with a visual acuity worse than 6/12 at a point in time. This includes people who are registered blind, but also those who are waiting for treatment and those whose sight loss is not severe enough for them to be eligible to a CVI or registration.
It is estimated that by the year 2020 this will have increased to 11,910[8]. This would be an extra 2,620 people living in the community with sight loss that impinges on their day-to-day life.
The reasons for this increase will be discussed in detail below, but the main reasons for this increase are; an aging population and lifestyle factors that place people at increased risk of sight loss.
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2. Main diagnoses of Blindness
Condition / Current PrevalenceAge Related Macular Degeneration (AMD) / 2990
Glaucoma / 2950
Diabetic Retinopathy / 6150
Cataracts / 2880
[9] RNIB Sight Loss Data Tool (Nov 2013)
[N.B. the figures included in this table are for vision impairment caused by eye-disease only. Therefore, those who experience vision impairment as a result of a neurological malfunction, accident or stroke are not included in these figures. The estimated number of people living with AMD, cataract, glaucoma and DR provides information on the number of people with these conditions. Those with wet AMD or glaucoma may not be considered to be living with sight loss at this stage because their sight may not have deteriorated due to ongoing treatment. Therefore the most accurate estimate of those actually living with sight loss remains at 7290 as detailed in 1.3 above.]
2.1. Age Related Macular Degeneration – This is the most common form of sight-loss in the UK and mainly affects people aged 50 and over. Estimates suggest that there are roughly 2,990 people in Barnet living with Age Related Macular Degeneration.
2.2. Glaucoma - this is caused by optic nerve damage, and while it cannot be cured early diagnosis and regular treatment can halt its progression. Estimates suggest that there are roughly 2,950 people in Barnet living with Glaucoma.
2.3. Diabetic Retinopathy - is a complication of diabetes, Retinopathy is also the leading cause of blindness in people under the age of 65. The Sight Loss Data Tool estimates that there are 5,520 people in Barnet with background Diabetic Retinopathy and 630 with non-proliferative and proliferative diabetic retinopathy.
Estimates suggest that there are roughly 17,000 people in Barnet who suffer from diabetes[10]. Around 80% of people living with diabetes for longer than 10 years will develop some degree of diabetic retinopathy. Consequently, without even accounting for an increase in the number of diabetics, within 10 years there is likely to be a further increase in people living with impaired vision in Barnet.
2.4. Cataracts – are also common in older people, but can be treated through surgery. Estimates suggest that there are roughly 2,880 people in Barnet living with Cataracts.
2.5. Accidents - changes in vision can also result from optic nerve damage caused by brain injuries. The most common cause of brain injuries is a blow to the head during car and motorcycle accidents. Research from the US has also suggested that sight loss tends to be higher amongst veterans given the higher likelihood of bodily injury, this phenomenon has become known as ‘blast trauma’.[11] Unfortunately, Barnet does not hold any statistics on the number of people who has sight loss resulting from an accident.
2.6. Cancer - there are several cancers that can cause problems with vision. The most direct cause is eye-cancer, which can necessitate the removal of one or both eyes. Regular eye check-ups can help spot the problem early and prevent the need for major surgery. Nasal and sinus cancers may also cause problems with vision, as can cancer of the nasopharaynx (the tube that connects the nose to the back of the mouth) and brain tumours.[12] Unfortunately, Barnet does not hold any statistics on the number of people whose sight loss is a result of cancer.
2.7. Neurological Conditions - There are also several neurological conditions that are closely associated with sight loss, the most common of which is Multiple Sclerosis (M.S.). This is a condition where the immune system attacks the brain, spine and optic nerves. One of the first symptoms of M.S. can be the loss or blurring of vision, therefore it is important that eye-health professionals are able to recognise symptoms and refer patients is necessary. Unfortunately, Barnet does not hold any statistics on the number of people who have sight loss resulting from a neurological condition.