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The Barking and Dagenham

Vision Strategy

‘Excellent eye care for local people’

2010 to 2015

Written by

Barking and Dagenham Council

Royal National Institute of Blind People

Action for blind people

NHS Barking and Dagenham

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Table of Contents

Page number

1 Introduction 3 2 Key Objectives 5 3 Local needs analysis 7 4 Local eye care services 20 5 Conclusion 29 6 Service Development Priorities 30

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1 Introduction

This strategy is a response to the UK Vision Strategy which, for the first time, brings interest groups together in a unified way to improve eye care services. The document is the result of collaborative work undertaken by the local Vision Strategy Group. This formed in 2008 and brings together Ophthalmology; Optometry; NHS commissioners; service users; carers and council staff. The UK Vision Strategy takes its lead from the World Health Assembly VISION 2020 resolution; its main aims being to reduce avoidable sight loss by the year 2020 and improve support and services for blind and partially sighted people. The UK Vision Strategy aims to:

Improve the eye health of the people of the UK Eliminate avoidable sight loss and deliver excellent support

to those with a sight problem Enhance the inclusion, participation and independence of

blind and partially sighted people For many years some excellent services have been delivered for visually impaired people who live in Barking and Dagenham. These have enabled people who experience sight loss to access the medical treatment that they need; along with glasses and magnifiers and rehabilitation. In the past, however, eye care services that are provided by the NHS have tended to be planned and delivered separately from those provided by the council. The same has been true for services delivered by the voluntary sector. The Barking and Dagenham Vision Strategy, in line with the UK Vision Strategy, brings together all of these initiatives in one place; developing a cohesive and coordinated response to the eye care and support needs of the people of Barking and Dagenham. The strategy is a joint initiative developed and to be delivered by a range of local stake holders including: service users; the Local Optical Committees, (LOC), the London Borough of Barking and Dagenham, NHS Barking and Dagenham, Barking, Havering and Redbridge University Hospitals (BHRUT), Action for Blind People and Independent Living Agency (ILA) .

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The strategy sets out:

Key objectives – the ambition driving the strategy A local needs analysis An overview of current services within health, social care, the

voluntary sector and other areas Priorities for service development.

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2 Key Objectives UK Vision Strategy Barking and Dagenham Vision Strategy is, first and foremost, a response to the ambitious agenda set out in the UK Vision Strategy. This was launched in April 2008 to address the aim of the World Health Assembly VISION 2020 resolution to reduce avoidable blindness by the year 2020 and improve support and services for blind and partially sighted people.

The UK Vision Strategy aims to:

Improve the eye health of people in the UK Eliminate avoidable sight loss and deliver excellent support

to those with a sight problem Enhance the inclusion, participation and independence of

blind and partially sighted people.

The strategy was developed with the involvement of 650 organisations and individuals including: visually impaired people, the Association of Directors of Adult Social Services (ADASS); the College of Ophthalmology and the major national third sector organisations. The strategy is also fully supported by the four UK Governments.

The UK Vision Strategy has now been translated into national strategies for each of the four UK countries. To view the documents, go to the UK Vision Strategy section of the Royal National Institute of Blind People (RNIB) website: http://www.rnib.org.uk

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Liberating the NHS: Eye Care – making a reality of equity and excellence (December 2010) This document sets out a vision for community eye care based upon an expanded role for high street Optometrists. It recognises that Optometrists are skilled in recognising and monitoring diseases of the eye but are greatly underutilised for this function. At the same time, the demands placed upon hospital Ophthalmologists are increasing, putting hospital eye care services under considerable pressure. Personalisation The White paper “our health, our care, our say”, the ‘Putting People First’ promise and the Government’s Vision for Adult Social Care all stress the importance of prevention and early intervention; and choice and control by older and disabled people over the way that they live their lives and receive the support that that they need.

The key messages within these documents that apply to sight loss include:

Extending the rollout of personal budgets, particularly those taken as a Direct Payment

Increasing preventative action in local communities Keeping people independent and helping to build the “Big

Society “ Breaking down barriers between health and social care

funding Encouraging care and support to be delivered in a

partnership between individuals, communities, the voluntary sector, the NHS and councils - including wider support services, such as housing

Enabling older and disabled people to have control over their own life and the services that they receive - participating as active and equal citizens and being treated with dignity and respect

This agenda represents a shift from traditional, service led, systems for delivering social care towards increased personalisation, where service users shape the way that their support is delivered, within an agreed budget.

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3 Local Needs Analysis Current picture of eye care needs in Barking and Dagenham Demography of the borough The local population is growing at a significant rate. The latest estimate for the number of inhabitants is 170,000 which represents an increase of more than 6,000 from the census figure of 163,944 in 2001. By 2020 the population is expected to reach 208,000, an increase of 38,000 over the next 10 years. There is expected to be a particular rise in the numbers of children, middle aged people and those aged over 90. Ethnic diversity According to the Barking and Dagenham Joint Strategic Needs Assessment (JSNA) 2009, 28% of residents in the Borough are from Black and Minority Ethnic groups. The impact of this migration is particularly significant in the schools in the area, where the population is now approximately 55% children from BME Communities and adults of child-bearing years.  Potential impact on eye health According to research by the RNIB and the Thomas Pocklington Trust some black and minority ethnic communities are more at risk of vision loss than others because of complex cultural and genetic factors. People of African origin, for instance, are more likely to suffer cataracts, have a threefold risk of developing diabetes, with its attendant risk of diabetic retinopathy, and four times more likely to contract glaucoma. People of Asian origin are also more at risk of developing glaucoma and cataracts and are six times more likely to develop type 2 diabetes, which affects as many as 25% of the Asian community in the UK. This susceptibility is compounded, according to RNIB, because black and minority ethnic groups are among the hardest to reach with healthcare messages and are less likely than their white counterparts to have their eyes examined.

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Economic disadvantage and low levels of education The levels of deprivation in the borough are high. Barking and Dagenham is the eleventh most deprived district in England (out of 354) and the sixth most deprived borough in London.

More than half of children live in families affected by poverty Residents have the lowest average income in London The top 25% of earners in Barking and Dagenham earn

about £15 per hour - lower than anywhere else in London According to Nomis – official labour market statistics (July

2009 to June 2010) - the working-age employment rate in Barking and Dagenham is 62.1%, compared to the London rate of 68.1% and England rate of 70.4%.

Barking and Dagenham’s population has the fourth lowest literacy levels and second lowest numeracy levels in England. The borough has the lowest percentage of 16 to 74 year old residents with qualifications in London. Potential impact on eye health Low levels of literacy make it more difficult to communicate awareness of preventable sight loss and educate on healthy living. Economic disadvantage means that many people may face sight loss which could be avoidable. Free NHS eye tests and help with the cost of glasses are available to people receiving certain benefits, and free examinations are on offer for children and the over 60s, yet cost still appears to dissuade many people from having their eyesight checked.

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Incidence of long-term conditions Map below shows the proportion of working-age adults with a limiting long-standing illness in London. It can be seen that rates in Barking and Dagenham fall into the top category, at over 15%.

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Poor Diet and Obesity Diet

A Government survey reveals that the borough falls within the bottom fifth nationally for health issues including life expectancy, cancer, heart disease and mortality rates for under 75s. According to a press release (September 2009) on the borough’s website, an average nine takeaways can be reached by any given person in the borough of Barking and Dagenham before they will reach a leisure centre. Potential impact on eye health Diets rich in fat and sugar put people at risk of developing large blood sugar fluctuations and eventually diabetes – the leading cause of blindness in working age people. There are more than 8400 people with diabetes living in Barking and Dagenham. 4.1% of residents in the borough have diabetes, which can lead to the preventable eye condition ‘diabetic retinopathy’. People with diabetes are also at a higher risk of glaucoma and cataracts. High blood pressure and cholesterol increase the risk of stroke or a central retinal artery occlusion. Both could lead to loss of vision. They can also put a person at increased risk of diabetic retinopathy, glaucoma and macular degeneration. Diets low in antioxidant-rich foods could increase the risk of cataract formation.

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Smoking

32% of Barking and Dagenham residents are active smokers compared with a national average of 20%

One person dies every day in Barking and Dagenham from a

smoking related disease Potential impact on eye health For adults, smoking cigarettes can lead to vascular problems of the eye such as vein occlusions, artery occlusions and optic nerve damage. It is particularly associated with the following eye diseases and disorders:

Cataracts. There is strong evidence that smoking, particularly pipe smoking, increases the risk of cataracts by three times

Uveitis. An inflammation of the middle section of the eye Age Related Macular Degeneration (ARMD). The

deterioration of central vision; smoking is a clearly established risk factor for ARMD (a three times risk compared to non-smokers)

Smokers with thyroid eye disease (Graves Ophthalmopathy) have poorer outcomes than non-smokers

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Alcohol A Public Health report on alcohol related mortality and hospital admissions was issued by Barking and Dagenham NHS Primary Care Trust in March 2008. At the time of the report, an Office of National Statistics survey (ONS) found that a quarter of adults in the borough aged 16 to 74 were hazardous drinkers, with 4% having a more severe drinking problem, and 7% rated as alcohol dependent. At that time there was an annual average of 500 hospital admissions directly related to alcohol. The screening tool used - the Alcohol Use Disorders Identification Test (AUDIT) - also found that younger people had higher AUDIT scores and were more likely to show signs of dependence than older people, and that AUDIT scores were significantly higher among white ethnic groups than in black or south Asian groups. It also showed that there is a high positive correlation between alcohol related admissions and social deprivation. Potential impact on eye health Drinking large quantities of alcohol may cause nutritional problems and may lead to toxic amblyopia, an optic nerve disease. Excessive alcohol intake during pregnancy can lead to foetal alcohol syndrome, which can lead to eye (ocular) anomalies Alcohol abuse, particularly in heavy smokers who have also neglected their diet, is known to cause a toxic, progressive optic neuropathy. This can cause bilateral, symmetrical, painless, visual impairment with loss of colour vision and a central visual field defect. Half of all violent crimes are alcohol-related and about a third of all domestic violence incidents are linked to alcohol misuse. It is inevitable that some of these events will include sight-threatening eye injuries.

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Drugs According to statistics (January 2011) provided by the local Drugs and Alcohol Action Team (DAAT), there are more than 750 people known to them in the borough with a drug addiction. 74% are male and 26% are female – the majority aged between 20 and 44. The three most common drugs used are heroin, cocaine and cannabis. Potential impact on eye health The use of amphetamines use can lead to reduced dilation of the pupil, which can lead to a risk of acute angle-closure glaucoma. Cocaine use can lead to corneal ulceration, which can lead to scarring and can cause permanent vision loss. Intravenously injected drugs can lead to ‘cutting agent’ deposits forming in the retina, which can then lead to loss of retinal circulation, rapid and sometimes severe sight loss. Marijuana can lead to eye redness, dilated pupils and can cause hallucinations.

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An ageing population

By 2034, 23% of the UK population is projected to be aged 65 and over, compared to 16% in 2009.

The fastest population increase has been in the number of those aged 85 and over, the “oldest old”. In 1984, there were approximately 660,000 people in the UK aged 85 and over. Since then the numbers have more than doubled reaching 1.4 million in 2009. By 2034 the number of people aged 85 and over is projected to be 2.5 times larger than in 2009, reaching 3.5 million and accounting for 5% of the total population.

Research carried out in 2008 showed that 64% of blind and 66% of partially sighted people in the UK were aged 75 or over. As people are clearly projected to live longer, so the incidence of age related sight loss will increase.

Potential impact on eye health As stated above, there vast majority of visually impaired people are well above retirement age. This is because there are several eye problems that are more common among people as they age. They may have few or no symptoms early on. Regular eye exams can pick up early changes, but if left untreated the following eye conditions can lead to vision loss and blindness:

cataracts corneal diseases and conditions dry eye glaucoma age-related macular degeneration (ARMD) and diabetic

retinopathy. ARMD is the most common cause of vision loss in those aged over 50. It causes a gradual loss of central (but not peripheral) vision, and has a huge impact on a person’s ability to carry out everyday tasks independently.

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Learning Disability There are approximately one and a half million people with a learning disability in the UK and around 550 registered in Barking and Dagenham. As many as a third of people with a learning disability also have sight loss. People with Down’s syndrome are particularly likely to have eye problems. The prevalence of sight problems increases dramatically with the severity of the learning disability and with age. One report found that people with a learning disability were likely to experience eye problems ten years earlier than the general population. ‘Bridge to Vision’ is the pioneering project set up by the Royal National Institute for Blind People (RNIB), which identified that for thousands of people with a learning disability, their sight loss may go ignored because they cannot communicate the problem. It recognised that carers and professionals may put diminished capabilities and challenging behaviours down to the disability. The project follows the entire eye-care process, from how to best gather information from a client before the appointment, to what tools and techniques can be used to diagnose sight problems. It delivers training to optometrists and eye care staff to make sure that people with a learning disability can have their vision fully assessed. ‘Bridge to Vision’ helps optometrists identify sight problems using different methods. For instance, half of the people with a learning disability may also have difficulty reading the alphabet – so the traditional eye-chart may not be an appropriate testing method for them.

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Deafblindness The national deafblind population statistics: Now: • There are 356,000 deafblind people in the UK, representing 572 per 100,000 people • 222,000 (62%) of those people are aged over 70 • 113,000 are adults aged 20 to 69 and 21,000 children Predicted increase by 2030 to: • 569,000 deafblind people (806 per 100,000 people), representing a 62% increase on 2010 figures • 418,000 of those people will be aged over 70 • 129,000 adults and 23,000 children The regional statistics for London indicate for 2010 that there are 34,419 people who have deafblindness. Barking and Dagenham Adult Services have currently identified 181 people with a significant combined sight and hearing loss. The Department of Health issued Social Care for Deafblind Children and Adults Guidance (LAC 2001(8)) in March 2001 under Section 7(1) of the Local Authority Social Services Act 1970. The Deafblind Guidance expects local authorities to:

Identify, make contact with and keep a record of the deafblind people locally.

Make sure that assessments are carried out by properly trained personnel.

Make sure that appropriate services are provided for deafblind people - remembering that individual services for people who are deaf or who are blind may not be appropriate for someone who is both deaf and blind.

Make sure that they have access to fully trained, one-to-one support workers if necessary.

Provide information in a suitable format which is accessible to deafblind people.

Make sure that a senior manager is given overall responsibility for deafblind services.

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Barking and Dagenham Adult Services comply fully with the guidance, making sure that dual sensory impairment is recognised as a unique disability that requires specialist knowledge and resources. Prevalence of visually impaired It is not possible to state precisely how many visually impaired people live in the borough because this information is not systematically collected in any one place. It is, however, possible to estimate this using a number of sources. The Local Government and Public Involvement in Health Act places a duty on upper-tier local authorities and PCTs to undertake a Joint Strategic Needs Assessment (JSNA). It is intended that this process will inform the targets and priorities set for the Local Area Agreement in meeting the future health and wellbeing needs of the community. The local JSNA 2009 estimated that 4.5% have significant sight impairment but that this rises to 20% of the population aged 75 and over (Visual Impairment and Disability in Great Britain 1996/7 survey of disability). The number of people registered with Barking and Dagenham as having a “sight impairment” (partially sighted) or “severe sight impairment” (blind) are listed below (figures as of November 2010). It must be stressed that these figures are only for those actually registered and, therefore, represent only a proportion of borough residents who are visually impaired. Age Sight impaired

(partially sighted)

Severely sight impaired (blind)

Total

0 to 17

29 23 52

18 to 65

127 175 302

66 and over

489 377 866

Total

645 575 1220

% of local population

0.38% 0.33% 0.72%

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(170,000) As might be expected the greatest concentration of people registered with a visual impairment are over 75. Of those registered at least 32% of people also have an additional physical disability. It can be seen that only a minority of visually impaired people are registered as “sight impaired” or “severely sight impaired” with the council. This indicates that significant numbers of visually impaired people may be failing to access specialist services that could help them. The 2009 local joint strategic needs assessment (JSNA) noted that it is not age alone that is linked to sight deterioration. For example, preventable glaucoma leads to early sight loss in four times more African Caribbean people than other populations. Diabetic retinopathy is more prevalent in Asian communities. Again, according to data held by Barking and Dagenham Adult Services, the breakdown of those registered in ethnicity terms is as follows: Ethnicity Sight

impaired (partially sighted’)

Severely sight impaired (blind)

Total

Asian

25 39 64 (5% of total)

Black

19 37 56 (5% of total)

White

548 451 999 (82% of total)

Other

53 48 101 (8% of total)

Total

645 575 1220

The National Eye Health Epidemiological Model (NEHEM), launched in October 2008 (using 2001 population data), is a commissioning tool which can be used to identify the need for eye care services including low vision, glaucoma, Age Related Macular Degeneration (ARMD) and cataracts by local area. The Vision Strategy group will explore the benefits of using the tool to inform needs information in Barking and Dagenham.

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The following data for Barking and Dagenham was extracted from www.eyehealthmodel.org.uk: Age related macular degeneration

1231

Glaucoma

2031 (high estimate)

Cataract

4702 (high estimate)

Low vision Impaired vision Low vision Severe sight impairment

2041 1737 299

Comparison with two other East London boroughs: Population

of borough

Number of people registered as sight impaired (partially sighted)

Number of people registered severely sight impaired (blind)

Total % of population registered with a visual impairment

Barking and Dagenham

170,000 645 575 1220 0.72%

Redbridge 250,000

810 916 1726 0.69%

Waltham Forest

218,341 740 467 1207 0.55%

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4 Local eye care services As mentioned above, local eye care services are delivered by a number of different organisations. The eye care pathway can be accessed at a number of points, as illustrated below.

Community Optometry (local optician) Within Barking and Dagenham the eye care journey often begins with an eye examination by an Optometrist (your local optician). The purpose of this is to correct refractive errors (to check whether glasses will improve your vision) and detect any eye health problems, at an early stage. Where further investigation is required, a referral is made to an Ophthalmologist (hospital eye specialist) sometimes via a letter to the GP. Outside of office hours patients are seen in the 24 hour Accident and Emergency Department at Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD.

General Practitioner Optometrist

Local Authority Receipt of CVI Registration Assessment

Rehabilitation

Low Vision Clinic

Assessment Eye testing Equipment

Hospital Ophthalmology

Investigation and treatment

Certification Eye Clinic Liaison

Officer

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On Monday to Friday, between 9am and 2pm Queens Hospital Eye Department Casualty service is also available There are currently 13 optometric practices in the area. These provide a good geographic spread across Barking, Dagenham and on the outskirts towards Chadwell Heath. Since the population of the area is 170 000, this means that on average there is one optometric practice for every 13077 residents. Many are of the practices are close to public transport links and or parking facilities. Therefore there is a good spread across the borough and also easy access for all residents. However looking at the numbers, it clearly is not the case that all residents are having an eye test (at least not with a local optician). For those who are housebound due to health issues Many of the above practices also provide domiciliary primary eyecare services. The area is also served by companies which are based outside the area but also provide domiciliary eyecare to Barking and Dagenham residents. Therefore there is no shortage of primary eyecare for general ‘eye testing’ whether a person is housebound or able bodied. Cataract Direct Referral Many if not all practices in the area have now implemented a direct referral pathway for patients considered in need of cataract surgery. Previously, a patient diagnosed with cataract would be sent to their GP with a letter from their optometrist. The GP would then refer the patient for cataract surgery to an ophthalmologist. Now, the optometrist within the relevant practice will discuss options surrounding cataract surgery and with the patient’s consent, will refer directly to certain ophthalmologists. This saves the patient time as he/she can next be seen at the hospital without needing an unnecessary GP visit in between. It also saves the NHS money and the GP an unnecessary visit. Enhanced Optometry for people with learning disabilities In 2010, an enhanced Optometry service was launched in the Borough. In large part this was a response to what local carers of people with a learning disability told us about the difficulties that people with a learning disability face in accessing local opticians. The new service has proved to be an effective tool in identifying eye conditions at an early stage.

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In Barking and Dagenham there around 500 local residents with a learning disability. Under the enhanced services, anyone registered with a learning disability that is resident in Barking and Dagenham can access a special Optometry service from four local practices. Staff have been specifically trained to carry out eye tests for those with a learning disability. They are supported by the community learning disabilities team and this service is free. The specially trained Optometrists try to put each person at their ease, taking longer than usual to carry out the eye examination, often seeing the same person on more than one visit in order to complete the full test. The Optometrists use special pictures and matching cards to check how well a person sees. Importantly though, the optometrist will detect eye health conditions which may need treatment. This service was set up with the help of the charity SeeAbility and more information and a list of opticians is available on their website at www.lookupinfo.org . Glaucoma Referral Refinement Currently a few practices are participating in this scheme. A person may be seen for an eye examination and may be displaying signs of glaucoma. Previously, an optometrist could send the person to secondary care via a letter to their GP to book a hospital appointment. Potentially the person would take a GP appointment and then wait possibly weeks or months for a secondary care appointment. Now, the optometrist can easily repeat some of the tests on the same day as the original appointment, or on a different day, dependant on the test required. However, this is at the patient’s convenience. Following these further tests, in many cases the results are ‘normal’ and the person is saved the unnecessary anxiety and time of having to attend an ophthalmology appointment only to be told that it was not required. For those who still display positive signs, their appointment will not be delayed by unnecessary appointments which have been filtered out by the optometrist, and should have a shorter waiting time for the ophthalmology appointment which is truly vital.

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Diabetic Retinopathy Screening This is an annual screening test whereby photographs of the eyes are taken to detect any eye disease in diabetic patients. This should not be confused with a full NHS eye examination which should also be carried out annually for a diabetic person. In Barking and Dagenham diabetic retinopathy screening is provided by The Homerton Hospital, at a fixed satellite site within Porters Avenue Polyclinic. There are currently 8427 people aged 12 and over living in Barking and Dagenham who are registered for diabetic eye screening. The screening service is working to make sure that everyone with diabetes has had an opportunity to be screened. Of those screened up to and including November 2012, over 1750 have retinopathy. Appointments have been offered to over 2100 people with diabetes who have failed to attend. The service has offered further appointments, so that everyone will have had at least three fixed appointments for screening, plus an open offer of being able to phone up and choose a screening date at any time. Around a further 1000 people were scheduled for screening by December 2010. Data provided by Dr John Anderson (Barts and the London NHS Trust, November 2010) As can be seen by the number of residents who have not attended an appointment, this is not convenient for many who experience problems with travelling to this site. Some residents, who may live within Barking and Dagenham but are registered with a GP in a neighbouring area, may be covered by schemes in the neighbouring boroughs. Some of these schemes are based in Optometric practices. These schemes allow the resident a choice of optometric practices in various locations, who can offer an appointment to suit them. These schemes allow much easier access to residents throughout the borough.

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Hospital eye service – ophthalmology The ophthalmology department at Queens’ Hospital (Romford) and Moorefield’s Hospital (City Road) provides diagnosis and treatment for eye disorders including injuries and those relating to medical conditions. The Moorefield’s outreach clinic (Upney Lane, Barking) deals with clinic appointments only and covers:

cataracts glaucoma medical retina optometry pre-admission assessment primary care.

If surgery is not an option, there is no suitable treatment available and spectacles will make little or no difference to the person, the ophthalmologist may offer to complete a ‘Certificate of Visual Impairment’ (CVI). The CVI is used to certify patients with low vision and records details of the eye condition, visual acuity and visual field. In summer 2011, this service moved to Barking Community Hospital. Eye Clinic Liaison Officer (ECLO) The Barking and Dagenham ECLO is based in Queen’s Hospital in Romford. The role of an ECLO is to support people at the point of diagnosis and enable them to access other services and support. ECLOs :

Liaise between the hospital eye department and local sensory Impairment and low vision services

Provide emotional support and signpost to counseling services

Provide information about a person’s eye condition Explain life changes and what difficulties a person may

expect to experience Explain what help and benefits a person can receive

because of their visual impairment Explain where a person may receive this help, both

nationally and locally Explain and provide information on the visual impairment

registration process

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Provide information in clear accessible formats appropriate to that person’s visual impairment need

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Low vision services We have a local low vision service based at Porter’s Avenue Health Centre. This is joint commissioned by the London Borough of Barking and Dagenham and NHS Barking and Dagenham and delivered by Action for Blind People. The initial appointment with a low vision therapist and Optometrist lasts up to two hours and includes the following:

A full eye examination Low vision assessment Advice on lighting and glare management Strategies to assist with residual vision

Small pieces of equipment to assist with reading and communication are supplied. Individuals receive training and support in how to use magnifiers, and these are provided free of charge on long term loan

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Local authority sensory impairment services Barking and Dagenham Council has a Sensory Impairment Team based at the Civic Centre, Dagenham. In the Team there are two Rehabilitation Officers for Visually Impaired People (ROVIs) and a specialist who works with people who have a dual sensory impairment (are visually and hearing impaired). Rehabilitation officers provide:

help to adjust to sight loss and to maintain independence emotional support assistance to overcome every day tasks assistance to make the best use of any residual sight assistance to retain skills or learn new skills mobility training advice on visual assistive technology information about other services Advice on employment leisure and further education opportunities.

Service development In line with the key prevention agenda set out in the original strategy, there have been some important developments within sensory services in Barking and Dagenham over the last couple of years:

The opening of Barking and Dagenham’s low vision service in autumn 2008, jointly commissioned by Barking and Dagenham Council, NHS Barking and Dagenham and delivered by Action for Blind People

The appointment of an Eye Clinic Liaison Officer (ECLO) at Queen’s Hospital, Romford

Joint working between hospital Consultants and local Optometrists

Specialist enhanced Optometry contract for people with learning disabilities

High profile events run to address prevention and raise awareness; coinciding with “Eye Health Week” and “World Sight Day”

The appointment of a trainee rehabilitation worker within the Council Sensory Team in order to “grow capacity

Awareness training carried out by the Local Authority Sensory Impairment Team for frontline staff in Adult Services and Extra Care Housing, with further basic awareness training programmes to be rolled out in the future. Following awareness

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training for care staff at Colin Pond Court and Harp House, Care Manager Pam Ripton gave the following feedback:

“I have to say, from a personal point of view, the course was brilliant... …I tried out what Dean said about making a hot drink in light coloured cup one morning. It was still dark when I got up so the only light I allowed myself in the kitchen was the glow from my illuminated kettle. I then made two cups of coffee, one in a white mug, one in a dark one. Simple idea but made a hell of a difference. Not quite the same as what Dean deals with all day everyday but did give me a little experience.”

The development of an information pack containing information on social care, local and national services, produced in large print and available in Braille

Joint working with leisure services and libraries to improve access by visually impaired people to sports and leisure opportunities.the setting up of training groups for newly registered clients

Creation of support groups such as the Macular Disease Support Group and the Dual Sensory Social Club

Through these services, people are getting to know one another, making contacts, sharing experiences and developing friendships.

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5 Conclusion As is shown in the preceding sections, the population of Barking and Dagenham has a much higher than average incidence of health problems that are associated with increased risk of sight loss. Coupled with this, the proportion of older people in the UK population is increasing rapidly. It can be seen, therefore, that the ambition of the UK Vision Strategy to eliminate avoidable sight loss is of particular relevance to the Borough. We are in a relative good position as we have some strong local eye care services and an active and well attended Vision Strategy Group. The challenges as we move forward, however, include: Educating local people about eye care and encouraging at risk

groups to have regular eye tests with an Optometrist Ensuring that people with a learning disability receive regular check

ups Further integrating services to make them easily accessible and

seamless for the people who use them Expanding the role of primary eye care providers to create a

seamless service; whilst reducing the burdens placed on GPs and secondary care.

Making further improvements to Reablement, Rehabilitation and low vision services to enable visually impaired people to be as independent as possible

Improving the accessibility and relevance of information for visually impaired people

Increasing the amount of emotional support available at and after the point of diagnosis and

Improving access to mainstream work, training and recreational opportunities

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6 Service Development Priorities Outcome Indicator 1. Reduction in avoidable sight Loss

Public information campaign - the general public in Barking and Dagenham is aware of eye health issues Staff awareness training - all relevant professionals have basic knowledge and skills in respect of eye disease, eye care and visual impairment support needs and services. Better utilisation and development of skills of existing primary eye care providers (e.g. local opticians) in line with ‘Liberating the NHS: Eye Care (2010) making a reality of equity and excellence’ The general public in Barking and Dagenham has easy access to primary eye services (e.g. eye tests from local opticians) and take up increases Groups and individuals with a higher risk of developing eye disease are made aware of and supported in accessing eye care services Increased take up of diagnostic tests such as retinal and glaucoma screening

2. People with sight loss are enabled to make best use of their remaining vision

Establish the new council OT and Sensory Service Integrate sensory rehabilitation with the Council Reablement Service Provide excellent community-based low vision services that are well integrated with services provided by local opticians Make sure low vision services comply with national guidelines Raise awareness and assist visually impaired people to access assistive technology: equipment, IT solutions, low vision aids, lighting and telecare

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3. People who need eye care treatment receive a prompt and high quality service, where possible, near to their home

People have ready access to hospital eye care services for complex conditions People in Barking and Dagenham requiring non-acute specialist eye care have access to services close to where they live People in Barking and Dagenham requiring general eye care services have access to services close to where they live Reinforce and expand existing primary eye care services for example local opticians Young people and their families experience a smooth transition from children’s to adult eye care services Barking and Dagenham eye care services are of the highest quality and address the needs of “hard to reach” groups, such as people with learning disability and some BME groups Raise awareness amongst carers for example carers of people with a learning disability about the importance of primary health care in eliminating avoidable sight loss.

4. Visually impaired people able to live independent and active lives, making choices about the way that the services that they need are delivered

Increase in the numbers of visually impaired people using Self Directed Support Provide prompt rehabilitation services that meet the needs of visually impaired people Make sure visually impaired people have access to information that is reliable and accessible about services, options, conditions, support networks Prevent the social isolation of visually impaired people Provide appropriate housing-related support for visually impaired people

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Maximise eligible registration as blind or partially sighted Eye care and sight loss support services function as a cohesive whole system

5. Social inclusion – visually impaired people able to access all local education, training and recreational opportunities

Increase in numbers of visually impaired people accessing learning and leisure opportunities Increased numbers of visually impaired people able to obtain and maintain paid employment Improved access to information on rights and services Demonstrable improvement in accessibility of public and commercial services Demonstrable improvement in the accessibility of external environments Minimise barriers to housing Demonstrable improvement in the accessibility of local public transport networks Make sure all sight loss support providers work on the ethos of accessing universal services Wider health care meets the needs of people with sight loss

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