Children S Visual Impairment Services

Specialist Children’s Services

Children’s Visual Impairment Services

Greater Glasgow and Clyde

Getting It Right for VI Children

AnnualReport

2014 - 2015

1. Introduction

In the last 7 years since the introduction of coordinated multiagency services for children with visual impairment ( VI ) across Greater Glasgow and Clyde significant progress has been made despite the challenges of funding pressures across all organisations. The practice of working together has become embedded and awareness of the wider specific needs of children with VI has increased. Activity and progress is demonstrated within the content of this report.

Significant change has occurred at national level with the introduction of VINCYP the national managed clinical network for children and young people with visual impairment. This is a body ,approved by Scottish Government and involving NHS, local authority and voluntary sector professionals, whose role it is to improve services and outcomes for children with visual impairment. National standards have been produced and our challenge is to develop a plan and move towards meeting each of these. This will require to be addressed through both the steering group and within individual organisations across the Health Board and Local Authorities. A self evaluation document is attached to this report which allows services to measure progress against the national standards ( Appendix 1 ) .

Service managers and all professionals are asked to consider how we can plan to meet these standards in the coming years and are invited to complete the template to aid this. Clearly this is a longterm task and services and the steering group will require to identify one or two tasks/ standards to prioritise per year. Feedback on this is invited through your representative on the steering group.

2.Integrated care pathways

The central referral pathway from all eye departments across GG&CNHSB is used to refer children to appropriate visual services timeously. This system is embedded in the practice of clinicians seeing children regularly . The pathway was recirculated to all hospital eye service clinicians again during this year and referral information and processes are accessible to all health staff through the ophthalmology area within GG&C Staffnet.Looking forward some adaptation will be required to consent processes once the VINCYP datacollection is rolled out to GG&C in 2016 but no difficulty with this is anticipated . Our pathways are fully compliant with the agreed national VINCYPpathway ( fig 1 )

3. Data collection

Data system

The database holds information about children with visual impairment across GG&C to allow for monitoring of due dates for review meetings etc and to quickly identify information when requested . The accuracy of information on children known to all services continues to improve year on year although, as demonstrated below, although this has not been achieved for all children as yet. Seeking consent at joint clinics and allocating a professional to seek this following a VIRG has helped to improve awareness. With the introduction of the national VINCYP datasystem expected in 2016 much more clinical information regarding level of vision etc should be available more easily to other agencies but a need for a local system to ensure joint processes will remain.

Table 1. Children recorded on database June 2014 and June 2015

* These numbers reflect the children known to the central VI health service within GG&C and will be biased to children attending Glasgow hospitals. They do not necessarily reflect the total number of children with visual impairment without a consent to share information In each area as that is unknown.

It is encouraging to note that the majority of children for whom consent to share information is not held have attended a joint clinic or been discussed at a multiagency review group and that lack of consent reflects, in the main, a failure to formally request and record this rather than a situation where children’s needs are not being identified and managed by multiagency teams.

The numbers of children known to have VI in each area and those who have had a joint clinic assessment and VIRG are detailed below Fig 2 . Note in some circumstances a clinic isinappropriate and where this has been documented these numbers have been included in the numbers with full compliance ( ie clinic and VIRG). Likewise the numbers of children not yet due a VIRG but scheduled for one in the future are included in those with full compliance. Timing of a joint clinic is important and is not necessarily best on first notification . Children also may be seen at a clinic and the conclusion of the assessment is that the child does not have a visual impairment

Figure 2 . Children with VI and clinic attendance/ VIRG discussion

Only one child was known to have a visual impairment and had consent held but had had neither a joint clinic or VIRG discussion .

4. Multiagency review

Visual Impairment Review Groups (VIRGs)continue to meet regularly in each local authority area according to an annual schedule and produce individual VI specialist advisory reports for children to support their overall care plan. The groups advise professionals on management , identify gaps and duplications in services and report them to relevant service managers in order to effect change for individuals and improve services. These groups are also responsible for updating service information for their area.

The number of meetings scheduled was calculated approximately according to population per local authority, however it is clear that there are pressures in Glasgow particularly due to large numbers. The numbers of children discussed per meeting will be increased in the coming year to ensure that there is access to appropriate multiagency specialist advice for all children although it is anticipated that the workload will be challenging.

Table 2. No of multiagency meetings and care plans produced in 2014/15

Issues identified as gaps / difficulties within services:

In the majority of cases the recommendations made at a VIRG can be progressed. Individual issues which occurred such as lack of transfer of information when a child changed school, lack of provision of equipment or delays in actioning advice on safety related to highlighting steps were quickly resolved on discovery and raising with staff responsible.

Service issues affecting children with VI however continue to be problematic:the lack of habilitation services within Inverclyde and East Dunbartonshire continue along with limited delivery within Glasgow. With economic pressures availability of some services has reduced with for example restriction of specific VI support to children attending specialist placements and delays of 9 months or more to access social work support. Staff shortages , with a lack of cover , have affected representation at some VIRG meetings in both Glasgow and East Renfrewshire.The steering group have also raised concerns with all local authorities regarding difficulties with accessing support and resources required to carry out homework and have requested that education and social work services jointly agree how to ensure provision in order that children are not disadvantaged through lack of equipment available for homework etc.

5. Service provision

a)Joint Functional Vision Assessment (FVA) Clinics

These clinics, run jointly between health and education,take place in the 6 LA areas and involve an orthoptist, optometrist,occupational therapist, VI Teachers and paediatrician. They are held outwith eye clinicsin order to improve cooperation and achieve a more accurate assessment of everyday function. Feedback from parents and professionals indicates that this is beneficial.Accommodation is variable and some progress has been made in improving this. The excellent accommodation provided by education within Glasgow remains as does that by social work in Inverclyde ( although some difficulties occurred during renovation ). Clinics in Renfrewshire have moved to health premises as previous accommodation within social work premises was increasingly problematic. Difficulties in East Dunbartonshire remain, restricting numbers . West Dunbartonshire remain in health premises and East Renfrewshire’s clinic was moved to a different school where there has been a temporary arrangement for 1 clinic so far. Solutions continue to be sought by the local teams where accommodation difficulties remain.

Table 3.Joint functional vision assessments

*1 clinic cancelled due to no VI teacher available

It is generally expected that 3 patients be appointed per clinic. This is not at present possible in East Dunbartonshire due to the accommodation. On some occasions the number of children able to be seen requires to be reduced due to their particular complexities . Clinics and the resultant reports continue to be wellreceived by parents and professionals.

At these clinics assessment for and provision of basic independence and low vision aids continues in order to reduce the need for multiple appointments for families and services. Numbers of these aids issued continues to reduce with only 4magnifiers and 8 independence aids being issued over the year.The inference is that the need for aids is being identified earlier, prior to clinic attendance. It is assumed that for LVAs, these are being supplied through the improved LVA clinic service.

Training continues to be provided to a wide range of professionals including doctors, orthoptists, occupational therapists from GGC and other health boards, VI teachers from our and other local authorities, and habilitation specialists again from our own and other organisations.

b)Habilitation Training ( Child Mobility and Independent Living Skills )

As highlighted through the VIRGs lack of services for children continue to be of concern.

Habilitation training remains a high priority for the group as lack of this affects individual’s social opportunities, employment prospects, educational opportunities and finances in addition to increasing the financial burden on the state.Economic pressures along with cessation of training in Scotland and lack of a recognised professional structure and organisation have compounded difficulties. This is a difficulty nationally and solutions are being sought through various eyecare groups and Scottish Government.

The West of Scotland mobility network was created to provide professional support and CPD opportunities. There has been little activity recently but meetings are due to restart in September 2015.

c)Early Intervention Nurse Specialist

This part-time post covering all GG&C has is fully funded permanent post funded by Specialist Children’s Services GG&CNHS Board. The nurse provides support and information to families following identification of their child having a visual impairment. She maintains close links with eye clinic clinicians within the children’s hospital, provides telephone advice, home visits, ward visits, advice on play and interaction , works closely with Visibility in the provision of parent and toddler groups and links with VI teachers once they become involved. She is mainly involved with families of young children but also supports young people who suffer visual loss in teenage years .

This model of service for supporting parents and children has been recognised nationally as a good model of practice.

d)Low Vision Aid Service

This service is designed to allow VI teachers to refer directly and to provide child specific clinics when they can attend with their pupils.Arrangements are in place across all areas, the clinics within Gartnavel having restarted. The intention is to provide a more child-centred service within the new Children’s Hospital following the move to the Southern general site.

6. Information / Communication

The i-needs website was launched in 2013 . This is sponsored by the Childrens VI Steering Group and run/ monitored on its behalf by Visibility. It has been designed with parents and a significant amount of the content is provided and directed by them. It was created to help in directing parents to the most useful information ( identified by our parents and professionals ) and give practical information on toys etc and local service information. Positive feedback has been received from families locally but also from national organisations. The web address is printed on all joint clinic reports and on business cards which professionals have been encouraged to give to families . Further development of the site information is anticipated in the coming year through the work of Visibility’s family workers , the VI specialist nurse and the children and families .

7.Monitoring and Strategic Overview

The Children’s Visual Impairment Steering Groupwith representation from all local authorities and the voluntary agencies meets biannually. The purpose of this group is to: maintain progress, monitor effectiveness, promote interagency working and links , develop services, promote research and act as a local expert group for local and central government.

8.Future Priorities

Improvement in our services , and hence outcomes for children , should be planned around the guidance produced by VINCYP . The main priority therefore is to evaluate our services against the national standards and pathway and develop an improvement plan based on this . Feedback on this is invited through your representative on the steering group. They are identified in Appendix 2.

Other work identified in previous years will also be progressed : continue to encourage and support sharing specialist equipment across LA boundaries,

seek solutions for provision of habilitation services to children, seek means of evidencing improved outcomes for children with VI

Dr Katherine Spowart, Locum Consultant Community Paediatrician and Clinical Lead Children’s Visual Impairment Services GGCNHSB

Appendix 1

A word document with this evaluation template also accompanies this report

Appendix 2

Children’s Visual Impairment Steering Group

Appendix 3 – Reporting pathways

Glasgow

Education

Morag Gunion , Head of Inclusion

Health

Jamie Redfern, General Manager of RoyalHospital for Sick Children

Stephen McLeod, General Manager of SCS

Jim Bretherton, Ophthalmology Service Manager, Acute Services for GGC

Social Work

Mike Burns , Head of Childrens services

Ann-Marie Rafferty , Head of Locality, North-East.

Jackie Kerr , Head of Locality , North West

David Walker , head of Locality , South

East Dunbartonshire

Education

Jacqueline MacDonald, Chief EducationOfficer

Health (as Glasgow plus)

Karen Murray, Director of East Dunbartonshire CHP

Mark Feinmann, Head of Specialist Children’s Services and Director of East CHP

Social Work

Freda McShane, Chief Social Work Officer

West Dunbartonshire

Education

Laura Mason, Head of Service

Social Workand Health (as Glasgow plus )

Jackie Irvine , Head of Health, Care & Criminal Justice

East Renfrewshire

Education

Janice Collins , Acting Head of EducationServices

Health (as Glasgow plus)

Kirsty Gilbert, service manager , East Renfrewshire

Lee Urquhart, Acting Service Manager for SCS in South GlasgowCHP

Social Work

Julie Murray, Head of Children’s Services and Criminal Services

Renfrewshire

Education

Gordon McKinlay, Head of Service

Health (as Glasgow plus)

Liz Daniels , Service manager for Specialist Children’s Services , Renfrewshire

Social Work

Peter MacLeod, Director of Childrens Services

Inverclyde

Education

Head of Education Services

Health (as Glasgow plus)

Fiona Houlihan ,Children’s Service Manager

Social Work

Sharon McAlees, Head of Service

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