People with a visual impairment
This page is part of the Joint Strategic Needs
Index of information on this page:
- The prevalence of sight loss increases with
age and the UK population is ageing. One in five people aged 75 and
over and one in two people aged 90 and over is living with sight
loss in the UK.
- The direct and indirect costs of sight loss
are estimated to have risen from £6.5 billion in 2008
to £7.9 billion in 2013. (RNIB 2009).
- Many patients with sight loss receive
appointments and information in formats that they cannot
read, thereby missing essential treatments that could
prevent further deterioration of their sight.
- The four leading causes of sight loss
are age-related macular degeneration (AMD), glaucoma,
cataracts and diabetic retinopathy.
- There is a wide range of impairment levels and it is important
that services are tailored to meet individual specific needs.
- Figures for Northumberland in April
2013 showed a total of over 1,474 people registered as
severely sight impaired, blind, sight impaired or partially
- There were 2,438 cataract operations for Northumberland
residents between Apr 2007 and March 2008 (the latest available ONS
data, 2009). This represents 12% of the cataract
operations that were carried out in the North East. Note it is not
uncommon for the same person to undergo two treatments in the same
- Visual impairment increases significantly with age. 44%
of those registered with a sight impairment are either severe sight
impaired or blind.
- Over half (54%) of those registered with a sight
impairment (803 people) are aged over 80 years old.
- 126 adults aged 18-64 who do not fall in other need groups are
also registered with severe sight impairments, and 115 with other
- There will also be a number of people with
sight loss below registrable levels whose specific needs will need
to be considered in service planning. These will include people
identified as having low vision (sight loss that is not correctable
- Groups at greater risk of sight loss also tend to be those most
vulnerable to exclusion from services. Such groups include
older people, people in the lower socio-economic groups, those in
residential care, those with poor mobility, those with dementia,
Black and Minority ethnic (BME) groups, those with multiple sensory
loss/impairment, those with learning difficulties, the prison
population, asylum seekers, refugees and travelling
Click here to find out what we are doing to
promote equality in Northumberland and how we are meeting our new
duties under the Equality Act 2010.
What we know:
There are 1.86 million people in the UK living
with sight loss. By 2020 this number is predicted to increase by
22 per cent and will double to almost four million people
by the year 2050. The increase can be mainly attributed to an
ageing population; over 80 per cent of sight loss occurs in people
over 60 years.
Age-related macular degeneration, glaucoma and
diabetic retinopathy have all increased in England and Wales since
1990- 91 and the number of people with diabetic retinopathy among
the over-65s has more than doubled.
Age-related macular degeneration
(AMD) commonly affects people over the age
of 50 and is the leading cause of blindness in people over the age
of 65. There are two main types: neovascular or exudative AMD
commonly known as wet AMD; and atrophic commonly known as dry
Early identification and treatment of wet AMD
is vital. Treatment can halt the further development of scarring
but lost sight cannot be restored. Dry
AMD can develop slowly and take a long time to
progress to its final stage. There is currently no treatment for
Glaucoma is a
group of eye conditions in which the optic nerve is damaged due to
changes in eye pressure. Damage to sight can usually be minimised
by early diagnosis in conjunction with careful regular observation
Cataracts - a
common eye condition that can get worse over time, prevalent in
older people, where the lens becomes misty or cloudy resulting
in poor vision. Cataracts surgery can improve
quality of life and reduce the number of falls (RNIB 2011).
retinopathy can lead to permanent sight loss,
therefore screening and early diagnosis with appropriate
intervention is essential. A Department of Health screening process has
The uptake of screening services for diabetic
retinopathy can be explored on the NHS
Atlas of Variation .
Evidence (cited in JSNA Guidance for Eye
Health, July 2012) shows:
- There is a link between people on low
incomes and living in deprivation and people living with sight
loss; three out of four blind or partially sighted people are
living in poverty or on its margins.
- Glaucoma is more common in African and
African-Caribbean populations. People from South-East Asia and
China are at higher risk of angle-closure glaucoma.
- People from the Asian population are at
a higher risk of developing cataracts. African, African Caribbean
and Asian populations are at a higher risk of developing diabetic
- There is a high prevalence rate
of visual impairment amongst adults with learning
disabilities. An estimated one in ten adults with learning
disabilities is blind or partially sighted and adults with learning
disabilities are 10 times more likely to be blind or partially
sighted than the general population
- The links between sight loss and other
health determinants include smoking, obesity and uncontrolled high
blood pressure. Strokes can result in visual impairment
(affecting 60% of stroke survivors).
- As the population ages an increasing
number of people will experience both dementia and sight
- Visual impairment is associated with a higher risk of
- People registered with a sight impairment are distributed
unevenly across the different localities in the county (April 2013
- 32% are in the Central
- 21% in the North
- 23% in the South and
- 23% in the West
- More detail of the position in Northumberland is available
What people have told us:
People receiving social care
services in Northumberland were surveyed as part of the Adult
Social Care User Survey in England 2010-11. Overall views were very
positive: overall satisfaction with the care and support people
were receiving was 93% - either extremely (31%) satisfied, very
satisfied (32%) or quite (30%) satisfied.
This is reflected in the
view that some key aspects of quality of life were mostly in
- People described their personal care positively: 53% feeling
able to present themselves in the way that they liked; 41% feeling
adequately clean and presentable.
- 64% of people felt they got all the food and drink they liked
when they wanted it; 30% felt their food and drink adequate.
- 60% felt their home was as clean and comfortable as they
wanted; 35% felt it was adequate.
- 62% of people felt as safe as they wanted; 30% felt adequately
However, views on overall
quality of life suggested that people would like to see
improvement: 47% of people felt extremely, very or quite satisfied.
Possible issues include:
- 72% of people felt they had as much control as they wanted over
daily life and 47% felt they had adequate control.
- 39% felt they had as much social contact as they would like,
and 36% had adequate social contact.
- 61% of people thought information and advice very easy or
fairly easy to find, 20% found it fairly difficult or very
difficult to find.
- Perhaps understandably in a county such as Northumberland,
satisfaction with getting around outside the home was an issue:
with 30% of people feeling able to get to all the places in their
area that they want; 27% acknowledging that at times this was a
challenge; 24% unable to get to the places they want and 19% unable
to leave their home.
A Northumberland Care Trust survey is Spring 2010 revealed
that key priorities for people with visual impairment were:
- More accessible out-patient services
- less delay in receiving community services
- staff with more expertise and understanding of sensory
Policy and research:
The UK Vision
Strategy is a cross-sector initiative, uniting all those in the
UK who want to take action on issues relating to vision. The
strategy is a VISION 2020 UK initiative led by Royal National
Institute of Blind People involving visually impaired people, eye
health and social care professionals, and statutory and voluntary
organisations. Developed in response to the World Health Assembly
VISION 2020 resolution, the UK Vision Strategy aims to reduce
avoidable sight loss by the year 2020 and improve support and
services for blind and partially sighted people.
The National Institute for Clinical Excellence (NICE) has
produced guidance and quality
standards on the diagnosis and management of chronic open angle
glaucoma (COAG) and of ocular hypertension, which includes the
monitoring of appointments and keeping a register of patients.
There is also
NICE commissioning guidance for services for people at
risk of developing glaucoma.
and Social Care Act 2012 came into force on 1 April
2013, resulting in major reform to health and social
care structures including public health, GP-led clinical
commissioning groups, health and wellbeing boards, and changes to
The Adult Social Care Outcomes Framework 2013/4 (DH,
This framework set out new measures for adult social care under
1. Enhancing quality of life for people with care and support
2. delaying and reducing the need for care and support
3. Ensuring that people have a positive experience of care
4. Safeguarding adults whose circumstances make them vulnerable and
protecting from avoidable harm
The framework is a key mechanism allowing government to set
priorities for adult social care and measure progress against
them. It is intended to link with similar frameworks for NHS
outcomes and public health outcomes.
The Public Health Outcomes Framework (DH,
2012) includes an indicator for eye health and sight
Draft Care and
Support Bill (HMG, 2012)
The draft Care and Support Bill was published alongside the
White Paper above consolidating the existing legislation into a
single law for adult care and support and providing the legal
framework for some of the main proposals in the White Paper.
Caring for our future: reforming care and support (HMG,
This White Paper built on the 2010 vision for social care with
proposals for a reformed care and support system, structured around
outcomes for the people who use services and their carers:
• “I am supported to maintain my independence for as long as
• “I understand how care and support works, and what my
entitlements and responsibilities are”
• “I am happy with the quality of my care and support”
• “I know that the person giving me care and support will treat me
with dignity and respect”
• “I am in control of my care and support”.
The Act consolidates all the anti-discrimination law
in Great Britain to ensure equal treatment in access to employment
as well as private and public services, regardless of
protected characteristics, inlcuding disability. Employers and
service providers are under a duty to make reasonable adjustments
to their workplaces to overcome barriers experienced by disabled
people. In addition, NHS bodies meet their duties
regarding reducing health inequalities under the Health and Social
Recognised, valued and supported: next steps for the carers’
strategy (HM Government, 2010)
Commissioning for personalisation: a framework for local authority
commissioners (DH, 2010) explores the commissioning
implications of a self-directed support system based on personal
budgets for adult social care.
Independent Living Strategy (DWP, DT, DH, DCSF, CLG, DIUS,
Office for Disability issues, 2008) and the
government’s response to consultation on the strategy.
Social Care Act 2008 established the Care Quality
Commission as the regulator of all health and adult social care
High quality care for all (DH, 2008)
Final report of Lord Darzi's NHS Next Stage
Review, responding to the 10 Strategic Health Authorities’
strategic visions and setting out a vision for an NHS with
quality at its heart.
People First (DH, 2007) set out the shared aims and values to
guide the transformation of adult social care, enabling people to
live their own lives as they wish, using high quality, safe
services which promote their own individual needs for independence,
well-being and dignity.
Improving the Life Chances of Disabled People (ODPM, 2005) - a
Joint report making recommendations for independent living; early
years and family support; transition to adulthood; and
Building Telecare in England (DH, 2005)
Government guidance on developing telecare
services setting out the purpose of the Preventative Technology
Our plans for the future:
The Joint Social Care and Health Commissioning Plan
2012-2015 for working age adults with a physical disability or
illness (Northumberland Care Trust, Northumberland County Council
and Northumberland Commissioning Group, 2012) sets out shared
commissioning intentions to promote independence, wellbeing and the
use of ordinary every day services. It includes a
commitment to work with people with visual impairments to
agree a new specification for visual impairment services by
considering the pathways currently in place, the appropriateness of
current service models and the range of support
There are also plans to increase capacity for diabetic retinal
screening in order to ensure that national targets are met in
addressing a major risk factor for sight loss.
The Northumberland Housing Strategy 2011/12 is over-arching and
includes housing and support for vulnerable groups.
Resilient for the Future: Sustainable Community Strategy for
Northumberland (NSP May 2011). The objectives and issues include
giving everyone a voice and influence, providing healthy lifestyle
choice and delivering services differently.
A preventative approach to Adult Social Care in Northumberland
(Northumberland NHS Care Trust and Northumberland County Council,
Describes how good information and advice, practical support,
appropriate housing options, reablement and joint working between
health and social care will assist people in living fulfilled and
independent lives and reduce the number of people requiring ongoing
support from social care.
Contact Adult Social Care
Telephone: 01670 536 400
Email address: Socialcare@northumbria.nhs.uk