People with a visual impairment

This page is part of the Joint Strategic Needs Assessment (JSNA)

Index of information on this page:

• Key Messages
• What we know

• What People have Told Us
• Policy and Research 
• Our Plans for the Future 

Key Messages:

• 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 sighted.

• 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 year).

• 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 sight impairments.

• 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 by spectacles).

• 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 populations.

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 AMD.

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 dry AMD.

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 and treatment.

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).

Diabetic retinopathy can lead to permanent sight loss, therefore screening and early diagnosis with appropriate intervention is essential. A Department of Health screening process has been introduced.

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.

• 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 eye disease.

• 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 loss.

• Visual impairment is associated with a higher risk of suicide.

• People registered with a sight impairment are distributed unevenly across the different localities in the county (April 2013 figures):

• 32% are in the Central locality
• 21% in the North
• 23% in the South and
• 23% in the West

• More detail of the position in Northumberland is available here. 

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 place:

• 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 safe.

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 impairment.

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. 

Health 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 regulation.

The Adult Social Care Outcomes Framework 2013/4 (DH, 2012)
This framework set out new measures for adult social care under four domains:
1. Enhancing quality of life for people with care and support needs
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 loss.

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, 2012)
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 possible”
• “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”.

Equality Act 2010

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 Care Act.

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.

Health and Social Care Act 2008 established the Care Quality Commission as the regulator of all health and adult social care services.

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.

 Putting 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 employment

Building Telecare in England (DH, 2005)

Government guidance on developing telecare services setting out the purpose of the Preventative Technology Grant.

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 available.

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, 2009)

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