RNIB – supporting people with sight lossFactsheet

Implementing the Care Act for blind and partially sighted peopleMay 2016

There are over two million people in the UK living with sight loss and this number is predicted to increase by 11 per cent in the next five years.

The impact of sight loss should not be underestimated. RNIB regularly hears from people who report feelings of isolation, frustration, depression and fear over their future.

Sight loss or deterioration in a person’s sight can be an overwhelming and challenging time. Everyday activities can seem like daunting obstacles to overcome. Making a cup of tea; shopping; crossing a road safely; reading post; cooking; continuing with working, and many other everyday activities can feel insurmountable.

There is a clear need for people to receive the right support at the right time. Early support means that people are able to learn and develop the right skills to ensure that they are able to continue with work, activities and way of life that is important to them. It can reduce, delay or prevent a person from needing far more costly care provision. However, some blind and partially sighted people will require ongoing care support.

The Care Act and accompanying statutory regulations and guidance should significantly improve social care provision for blind and partially sighted people. For the first time, vision rehabilitation services for blind and partially sighted people are acknowledged in statutory guidance.

Contents

RNIB charity numbers 226227, SC039 316 and 1109

Implementing the Care Act for blind and partially sighted people...1Details of Care Act......................................................................2

1. Initial contact with the council...........................................22. The right assessment at the right time..............................33. Vision rehabilitation services; Preventing, reducing or delaying needs.........................................................................84. Information and advice....................................................135. Eligibility............................................................................156. Charging.........................................................................19Further information................................................................20END.......................................................................................20

Details of Care Act

1. Initial contact with the council

Blind and partially sighted people might contact their local authority via a number of referral routes including, a Certificate of Vision Impairment (CVI), by other agencies, by family or friend member, or a self referral.

A local authority should make contact with an individual within two weeks of receiving the CVI [22.16], and this should be the start of the assessment process. It is a statutory duty that local authorities must maintain registers for blind (severely sight impaired) and partially sighted people (sight impaired). 22.16 Upon receipt of the CVI, the local authority should make contact with the person issued with CVI (regardless of whether the person has decided to register or not) within 2 weeks to arrange their inclusion on the local authority’s register (with the person’s informed consent) and offer individuals a registration card as identified on the CVI registration form. Where there is an

2

appearance of need for care and support, local authorities must arrange an assessment of their needs in a timely manner.

Registration should be activity offered and explained, however if a person decides not to be registered it should not impact on their right to receive an assessment [22.2].

22.2 Registration is voluntary, however individuals should be encouraged to consent to inclusion on the register as it may assist them in accessing other concessions and benefits. The data which local authorities are provided on registration are also of benefit in service planning for health and care and support. However, individuals’ access to care and support is not dependent upon registration, and those with eligible needs for care and support should continue to receive it regardless of whether they consent to inclusion on the register.

Registration data should be used to help inform service provision, however, statutory guidance is also clear that people who have not met the criteria for certification still need to be considered in service planning [22.14]. 22.14. Local authorities should note that there will also be people who have a reduced/low vision but do not meet the criteria for certification who may need to be considered in service planning.

2. The right assessment at the right timeAssessments are essential in determining that a person receives the right support. Depending on the local authority system, usually one or a combination of the following assessments are offered;

A care assessment to determine eligibility for care support. This assessment can be paused whilst preventative services, such as vision rehabilitation services are explored.

An assessment for vision rehabilitation services, which may include equipment, learning skills in the home and mobility

3

training. This assessment must not be subject to official care support eligibility criteria as it is a preventative service.

A generic assessment, to determine whether or not they should be referred for a vision rehabilitation or care support assessment.

RNIB is calling for everyone with a visual impairment to be offered a specialist vision rehabilitation assessment within 28 days of contact with the local authority.

AssessmentsAn assessment must be appropriate. RNIB believes that given the specific needs of blind and partially sighted people, it is appropriate to offer everyone a specialist assessment. Statutory guidance sets out that:

There is a clear expectation that the assessment process should start from when the local authority begins to collect information about that person [6.2].

The assessment may be the only contact the local authority has with the individual at that point in time, so it is critical that the most is made of this opportunity [6.4].

The assessment aim is to identify needs and outcomes to help people improve wellbeing [6.5].

6.2 The assessment process starts from when local authorities begin to collect information about the person, and will be an integral part of the person’s journey through the care and support system as their needs change. It should not just be seen as a gateway to care and support, but should be a critical intervention in its own right, which can help people to understand their situation and the needs they have, to reduce or delay the onset of greater needs, and to access support when they require it. It can also help people to understand their strengths and capabilities, and the support available to them in the community and through other networks and services.

4

6.5 The aim of the assessment is to identify what needs the person may have and what outcomes they are looking to achieve to maintain or improve their wellbeing. The outcome of the assessment is to provide a full picture of the individual’s needs so that a local authority can provide an appropriate response at the right time to meet the level of the person’s needs. This might range from offering guidance and information to arranging for services to meet those needs. The assessment may be the only contact the local authority has with the individual at that point in time, so it is critical that the most is made of this opportunity.

Assessments and prevention Guidance sets out that an assessment is important to identify any prevention needs [6.60]. A local authority can ‘pause’ an assessment, if they think that the person would benefit from preventative services [6.62].

6.60 The assessment and eligibility framework should be a key element of any prevention strategies authorities put in place. It is during the assessment where local authorities can identify needs that could be reduced, or where escalation could be delayed, and help people improve their wellbeing by providing specific preventive services, or information and advice on other universal services available locally. Early interventions can prevent or delay a person’s needs from progressing.

6.62 Where the local authority judges that the person may benefit from such types of support, it should take steps to support the person to access those services. The local authority may ‘pause’ the assessment process to allow time for the benefits of such activities to be realised, so that the final assessment of need (and determination of eligibility) is based on the remaining needs which have not been met through such interventions. For example, if the local authority believes that a person may benefit from a short-term reablement service which is available locally, it may put that in place and complete the assessment following the provision of that service.

5

Knowledgeable and competent staff The person being assessed should be able to participate in the process as effectively as possible. Assessments must be carried out by a person that has the necessary skill, knowledge and competency. Statutory regulations sets out that:

Training, expertise and consultation5.—(1) A local authority must ensure that any person (other than in the case of a supported self assessment, the individual to whom it relates) carrying out an assessment—(a) has the skills, knowledge and competence to carry out the assessment in question; and(b) is appropriately trained.

(2) A local authority carrying out an assessment must consult a person who has expertise in relation to the condition or other circumstances of the individual whose needs are being assessed in any case where it considers that the needs of the individual concerned require it to do so.

(3) Such consultation may take place before, or during, the carrying out of the assessment.

There must also be a professional on hand to help and provide advice on a particular condition or circumstance [6.86].

6.86 Where the assessor does not have the necessary knowledge of a particular condition or circumstance, they must consult someone who has relevant expertise. This is to ensure that the assessor can ask the right questions relating to the condition and interpret these appropriately to identify underlying needs. A person with relevant expertise can be considered as somebody who, either through training or experience, has acquired knowledge or skill of the particular condition or circumstance. Such a person may be a doctor or health professional, or an expert from the voluntary sector, but there is

6

no obligation for the local authority to source an expert from an outside body if the expertise is available in house.

Assessment for deafblind This must be carried out by a person with the specialist expertise.

Requirement for specialist expertise – deafblind individuals6.—(1) An assessment which relates to an individual who is deafblind must be carried out by a person who has specific training and expertise relating to individuals who are deafblind.(2) A local authority must facilitate the carrying out of the assessment by providing any person carrying out such an assessment with any relevant information which it may have—(a) about the individual whose needs are being assessed; and(b) in the case of—(i) a carer’s assessment, about the adult needing care;(ii) a child’s carer’s assessment, about the child needing care;(iii) a young carer’s assessment, about the adult needing care.

(3) In this regulation, an individual is “deafblind” if the individual has combined sight and hearing impairment which causes difficulties with communication, access to information and mobility

InterpreterStatutory guidance recognises blindness as a condition affecting communication which might require the local authority to provide an interpreter to enable the individual to complete a joint assessment [6.85]. 6.85 When assessing particularly complex or multiple needs, an assessor may require the support of an expert to carry out the assessment, to ensure that the person’s needs are fully captured. Local authorities should consider whether additional relevant expertise is required on a case-by-case basis, taking into account the nature of the needs of the individual, and the skills of those carrying out the assessment. The local authority must ensure that the person is able to be involved as far as possible, for example by

7

providing an interpreter where a person has a particular condition affecting communication – such as autism, blindness, or deafness.

3. Vision rehabilitation services: Preventing, reducing or delaying needs

Statutory regulations set a framework for “intermediate care and reablement support services” and “community equipment (aids and minor adaptations)” and the charging for such provisions.

Vision rehabilitation servicesRehabilitation services for blind and partially sighted people are formally recognised within statutory guidance. Guidance defines rehabilitation to include ‘living skills and mobility training for people with visual impairment’ [2.13]. Rehabilitation support for visually impaired people is recognised as a form of intermediate care and reablement. The guidance states that rehabilitation should not be limited to 6 weeks [2.62].

2.13 The term ‘rehabilitation’ is sometimes used to describe a particular type of service designed to help a person regain or re-learn some capabilities where these capabilities have been lost due to illness or disease. Rehabilitation services can include provisions that help people attain independence and remain or return to their home and participate in their community, for example independent living skills and mobility training for people with visual impairment.

8

2.62 Whilst they are both time-limited interventions, neither intermediate care nor reablement should have a strict time limit, since the period of time for which the support is provided should depend on the needs and outcomes of the individual. In some cases, for instance a period of rehabilitation for a visually impaired person (a specific form of reablement) 2, may be expected to last longer than 6 weeks. Whilst the local authority does have the power to charge for this where it is provided beyond 6 weeks, local authorities should consider continuing to provide it free of charge beyond 6 weeks in view of the clear preventative benefits to the individual and, in many cases, the reduced risk of hospital admissions.

Statutory guidance clearly defines rehabilitation support as a form of preventative tertiary intermediate and reablement support [2.9]. Guidance is explicit that a local authority is responsible for providing preventative support to all adults, irrespective of whether the person has eligible needs [2.3]. Eligibility criteria must not be applied to accessing rehabilitation services [2.3].

Delay: tertiary prevention2.9 These are interventions aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, (including progressive conditions, such as dementia), supporting people to regain skills and manage or reduce need where possible. Tertiary prevention could include, for example the rehabilitation of people who are severely sight impaired (see also chapter 22 sight registers). Local authorities must provide or arrange services, resources or facilities that maximise independence for those already with such needs, for example, interventions such as the provision of formal care such as meeting a person’s needs in their own home; rehabilitation/reablement services, e.g. community equipment services and adaptations; and the use of joint case-management for people with complex needs.

9

2.3 The local authority’s responsibilities for prevention apply to all adults, including:

people who do not have any current needs for care and supportadults with needs for care and support, whether their needs are eligible and/or met by the local authority or not (see chapter 6)carers, including those who may be about to take on a caring role or who do not currently have any needs for support, and those with needs for support which may not be being met by the local authority or other organisation

Training Guidance recognises the specific skill set needed to deliver vision rehabilitation support. Local authorities are advised to consider securing specialist rehabilitation and assessment provision, in order to identify the specific needs of blind and partially sighted people and to maximise independence [22.21].

22.21. Local authorities should consider securing specialist qualified rehabilitation and assessment provision (whether in-house, or contracted through a third party), to ensure that the needs of people with sight loss are correctly identified and their independence maximised.

Certain aspects of independence training with severely sight impaired and sight impaired people require careful risk management and should only be undertaken by professionals with relevant experience and training. This type of rehabilitation should be provided to the person for a period appropriate to meet their needs. This will help the person to gain new skills, for example, when training to use a white cane. As aspects of rehabilitation for people with sight loss are distinct from others refer to the Association of Directors of Adults Social Services’ (ADASS) position statement of December 2013.164 Vision rehabilitation services should not be charged for

10

Rehabilitation is defined as an intermediate or reablement programme, and therefore must be free of charge for six weeks. However, because of the clear benefits of rehabilitation, and since the intervention will in many circumstance need to be provided for longer than six weeks, the government strongly urge local authorities not to charge for any it any stage [2.61].

2.61 Where local authorities provide intermediate care or reablement to those who require it, this must be provided free of charge for a period of up to 6 weeks. This is for all adults, irrespective of whether they have eligible needs for ongoing care and support. Although such types of support will usually be provided as a preventative measure under section 2 of the Act, they may also be provided as part of a package of care and support to meet eligible needs. In these cases, regulations also provide that intermediate care or reablement cannot be charged for in the first 6 weeks, to ensure consistency.

Aids and adaptations The Care and Support (Eligibility Criteria) Regulations 2014 state that there should be no charge for aids, and minor adaptations provided at a cost of £1,000 or less;

Interpretation2. “Community equipment (aids and minor adaptations)” means an aid, or a minor adaptation to property, for the purpose of assisting with nursing at home or aiding daily living and, for the purposes of these Regulations an adaptation is minor if the cost of making the adaptation is £1,000 or less;

Services to be provided free of charge4. A local authority must not make a charge under regulation 3(1) where the provision made under section 2(1) of the Act is –(a) a service which consists of the provision of community equipment (aids and minor adaptations);

11

(b) intermediate care and reablement support services for the first 6 weeks of the specified period or, if the specified period is less than 6 weeks, for that period.

Aids and adaptations should include any equipment which is recommended through a rehabilitation intervention, or through an assessment. This may include, white canes, kitchen equipment, magnification and screen readers (this is not an exhaustive list).

2.59. The regulations require that intermediate care and reablement provided up to six weeks, and minor aids, and adaptations up to the value of £1,000 must always be provided free of charge (see also 8.14).

8.14 Community equipment (aids and minor adaptations). Aids must be provided free of charge whether provided to meet or prevent/delay needs. A minor adaptation is one costing £1,000 or less

Planning for services Local authorities should develop a local approach to understand and plan for local needs. They should also ‘consider the different opportunities for coming into contact with those people who may benefit from preventative support, including where the first contact may be with another professional outside the local authority [2.38].

2.38 In developing such approaches, local authorities should consider the different opportunities for coming into contact with those people who may benefit from preventative support, including where the first contact may be with another professional outside the local authority, for example, GPs, pharmacists or welfare and benefit advisers. There are a number of interactions and access points that could bring a person into contact with the local authority or a partner organisation and act as a trigger point for the local authority to consider whether the provision of a preventative service, or some other step is appropriate.

12

Local authorities should consider the impact and consequences of ending preventative services, as poor exit strategies can have a significant impact on preventing, reducing and delaying needs [2.63].

2.63 Local authorities should consider the potential impact and consequences of ending the provision of preventative services. Poorly considered exit strategies can negate the positive outcomes of preventative services, facilities or resources, and ongoing low-level care and support can have significant impact on preventing, reducing and delaying need.

RNIB has produced a sight loss data tool which provides statistics on sight loss broken down to a local authority level for the UK. It is a free tool and provides information at www.rnib.org.uk/datatool

4. Information and adviceThere is a duty on the local authority to provide information and advice. Information services must have due regard for the needs of people with a visual impairment [3.2].

3.2 Local authorities must ‘establish and maintain a service for providing people in its area with information and advice relating to care and support for adults and support for carers’.

Guidance is clear that local authorities should consider the accessibility of information for blind and partially sight when providing this service itself or in partnership with other providers [3.3]. Local authorities should also consider how information is provided and ensure that it is in a format that is preferred by the individual [3.29]. Local authorities should have due regard to the accessibility needs of blind and partially sighted people [3.30].

3.3 The local authority has an active and critical role in the provision of information and advice and must take an active role. To fulfil its duty under section 4 of the Act, a local authority is likely to need to go further than providing information and advice directly

13

(though direct provision will be important) by working to ensure the coherence, sufficiency, availability and accessibility of information and advice relating to care and support across the local authority area. Importantly, this duty to establish and maintain an information and advice service relates to the whole population of the local authority area, not just those with care and support needs or in some other way already known to the system.

3.29. Advice and information content should, where possible, be provided in the manner preferred by the person and will therefore often need to be available in a number of different formats. The duty in the Care Act will not be met through the use of digital channels alone, and information and advice channels are likely to include all of the following:face-to-face contact;

use of peer-to-peer contacts;community settings;advice and advocacy services;telephone;GP surgeries;use of ‘free’ media such as newspaper, local radio stations, social media;local authority’s own and other appropriate internet websites, including support for the self-assessment of needs;third party internet content and applications;email.

3.30. Some groups in need of information and advice about care and support may have particular requirements. Local authorities must ensure that their information and advice service has due regard to the needs of these people. These include, but are not limited to: people with sensory impairments, such as visual impairment, deafblind and hearing impaired;

14

It is important to not that regulations and guidance do not replace local authority’s responsibilities under the Equality Act.

3.28 As required under the Equality Act 2010, reasonable adjustments should be made to ensure that disabled people have equal access to information and advice services. Reasonable adjustments could include the provision of information in accessible formats or with communication support.

Information, advice and prevention Local authorities cannot rely on their information and advice services to fulfil their duty to prevent, delay and reduce needs. The requirement to provide information and advice is separate to any other duty in the Act [3.4].

3.4 It is important to be clear that the duty to establish and maintain an information and advice service is distinct from the duty to meet eligible needs (see chapter 6): this is true for both people with care and support needs and their carers. While a person’s eligible needs may be met by the provision of information and advice this will be an individual response following a needs or carer assessment. Local authorities cannot fulfil their universal information and advice duty simply by meeting eligible needs, and nor would information and advice always be a appropriate of way of meeting eligible needs.

5. Eligibility The government has set the minimum eligibility criteria, at ‘significant’. This is roughly equivalent to ‘substantial’ under FACs.

The criteria for assessing whether a person has significant care needs, is divided into a three tier "test."

2.—(1) An adult’s needs meet the eligibility criteria if— (a) the adult’s needs arise from or are related to a physical or mental impairment or illness; (b) as a result of the adult’s needs the adult is unable to achieve two or more of the outcomes specified in

15

paragraph (2); and (c) as a consequence there is, or is likely to be, a significant impact on the adult’s well-being.

a) Physical impairment

Firstly the person must be an adult and have needs that have arisen from a physical or mental impairment or illness. Guidance defines physical impairment to include a person with a sensory impairment.

b) Unable to achieve outcomes

A full list of the defined outcomes is set out below. It is clear that many blind and partially sighted people will experience difficulties in meeting these outcomes, and should qualify for support.

(a) managing and maintaining nutrition; (b) maintaining personal hygiene; (c) managing toilet needs;(d) being appropriately clothed; (e) being able to make use of the adult’s home safely; (f) maintaining a habitable home environment; (g) developing and maintaining family or other personal relationships; (h) accessing and engaging in work, training, education or volunteering; (i) making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and (j) carrying out any caring responsibilities the adult has for a child.

The regulations define what it could mean to be unable to do any of these above activities. Two of the four areas that are of particular relevance: if they need assistance, or if they can do the activity without assistance but it takes significantly longer. Therefore a person with a visual impairment could qualify for support under this criterion.

16

Guidance sets out further explanations of what may be involved with meeting an outcome. Many of the criteria reflect the everyday challenges blind and partially sighted people face. Of particular note is the inclusion of laundering of clothes (b); maintaining of amenities (f) as blind and partially sighted people are unable to read meters and correspondence, and therefore are unable to maintain their amenities; and the inclusion of getting around the community safely (i).

(b) maintaining personal hygiene. Local authorities should, for example, consider the adult’s ability to wash themselves and launder their clothes.

(f) maintaining a habitable home environment. Local authorities should consider whether the condition of the adult’s home is sufficiently clean and maintained to be safe. A habitable home is safe and has essential amenities. An adult may require support to sustain their occupancy of the home and to maintain amenities, such as water, electricity and gas.

(i) making use of necessary facilities or services in the local community including public transport and recreational facilities or services. Local authorities should consider the adult’s ability to get around in the community safely and consider their ability to use such facilities as public transport, shops or recreational facilities when considering the impact on their wellbeing. Local authorities do not have responsibility for the provision of NHS services such as patient transport, however they should consider needs for support when the adult is attending healthcare appointments.

i. Significant impact

The third tier of the "test" is whether the impact on the individual’s wellbeing is "significant”. Significant is defined by its everyday meaning [6.123]. Local authorities should understand what needs are important to the individual, therefore what is significant for one person may not be for another [6.108].

17

6.123 The term ‘significant’ is not defined by the Regulations, and must therefore be understood to have its everyday meaning. Local authorities will have to consider whether the carer’s needs and their inability to achieve the outcomes will have an important, consequential effect on their daily lives, their independence and their own wellbeing.

6.108 In making this judgment, local authorities should look to understand the adult’s needs in the context of what is important to him or her. Needs may affect different people differently, because what is important to the individual’s wellbeing may not be the same in all cases. Circumstances which create a significant impact on the wellbeing of one individual may not have the same effect on another.

However, the significant impact on well being could included the following; 6.109a) personal dignity (including treatment of the individual with respect)b) physical and mental health and emotional wellbeingc) protection from abuse and neglectd) control by the individual over day-to-day life (including over care and support provided and the way it is provided)e) participation in work, education, training or recreationf) social and economic wellbeingg) domestic, family and personal relationshipsh) suitability of living accommodationi) the individual’s contribution to society

Cumulative impactNot all outcomes must have an individual significant impact on wellbeing, but rather the cumulative impact must be considered.

18

6.106 Local authorities must determine how the adult’s inability to achieve the outcomes above impacts on their wellbeing. Where the adult is unable to achieve more than one of the outcomes, the local authority does not need to consider the impact of each individually, but should consider whether the cumulative effect of being unable to achieve those outcomes is one of a ‘significant impact on wellbeing’. In doing so, local authorities should also consider whether:

If a person is found to have eligible needs, but their carer, partner is able to and willing to provide the support then the local authority does not have to meet that eligible need.

The carer is however, entitled to an assessment and will be assessed for their eligibility.

6. Charging As previously indentified vision rehabilitation should not be charged for, and community equipment (aids and minor adaptations). Aids must be provided free of charge whether provided to meet or prevent/delay needs. A minor adaptation is one costing £1,000 or less.

Treatment of incomeAnnex C ‘treatment of income’, local authorities are provided with “detailed guidance on how to apply the Care and Support (Charging and Assessment of Resources) Regulations 2014, and how to treat different types of income when calculating what a person can afford to contribute to the cost of their eligible care needs.”

The guidance only applies when a person is to be charged for a service and the local authority undertakes a financial assessment. In doing this the income and capital of the person must be assessed.

19

When assessing income and finances of a disabled person there are a number of expenditures related to the disability which must be discarded, this now includes internet connection.

Disability – related expenditure45. In assessing disability - related expenditure, local authorities should include the following:

xiv. internet access for example for blind and partially sighted people

Further information

Please contact Tara Chattaway, Policy and campaigns officer, social care.

Tara.chattaway@rnib.org.uk 01179 341 707

Campaigns@rnib.org.uk 020 7391 2123

END

20