Implementing the Care Act for blind and partially sighted people

May2016

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 canbe 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

Implementing the Care Act for blind and partially sighted people

Details of Care Act

1.Initial contact with the council

2.The right assessment at the right time

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

4.Information and advice

5. Eligibility

6.Charging

Further information

END

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 thatlocal authorities must maintain registers for blind (severely sight impaired) and partially sighted people (sight impaired).

22.16 Upon receipt of theCVI, 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 theCVIregistration form. Where there is an 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/lowvision but do not meet the criteria for certification who may need to be considered in serviceplanning.

2.The right assessment at the right time

Assessments are essential in determining that a person receives the right support. Depending on the local authority system, usuallyone or a combination of the following assessments areoffered;

  • 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 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.

Assessments

An 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. Statutoryguidance 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.

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.

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 consultation

5.—(1) A local authority must ensure that any person (other than in the case of a supported selfassessment,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 relationto the condition or other circumstances of the individual whose needs are being assessed in any casewhere 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 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 individuals

6.—(1) An assessment which relates to an individual who is deafblind must be carried out by a personwho 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 personcarrying 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 hearingimpairment which causes difficulties with communication, access to information and mobility

Interpreter

Statutory 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 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 services

Rehabilitation 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.

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 prevention

2.9 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.

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 support

adults 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 withrelevant 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

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.