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Good practice in sight How excellent services for blind and partially sighted adults can boost the overall performance of local authorities Contents Foreword by Ivan Lewis MP, Parliamentary Under Secretary of State for the Department of Health Foreword by Anne Bristow, Chair of the Sensory Impairment Group, ADASS Introduction How an excellent service for blind and partially sighted people can help local authorities and social services meet their own performance targets What is good social care? Good practice benchmark 1 - Emotional support Good practice benchmark 2 - Referral Good practice benchmark 3 - Information and advice Good practice benchmark 4 - Assessment Good practice benchmark 5 - Equipment Good practice benchmark 6 - Training Good practice benchmark 7 - User involvement Good practice benchmark 8 - Dealing with complaints Good practice benchmark 9 - Inter-agency working Appendix. National Indicators under the new performance framework for local authorities and local authority partnerships Acknowledgements Footnotes are presented at the end of sections.

Foreword by Ivan Lewis MP, Parliamentary Under Secretary of State for the Department of Health This guide to good practice in the provision of services to blind and partially sighted people is a welcome contribution to the Government's Independent Living Strategy. It builds on key messages about the importance of independence, choice and control as the centre of service delivery.

At the same time it recognises that local authorities are measured against specific outcomes and national performance indicators. Good Practice in Sight shows local authorities how a holistic, person- centred approach to the delivery of services that focuses on a defined number of key outcomes for blind and partially sighted people can help them reach their performance targets. Significantly, the guide is also an integral part of the UK Vision Strategy - a welcome reminder to Government of the importance of sight, the prevention of sight loss and most importantly in this context, not just adequate but excellent services for blind and partially sighted people.

Foreword by Anne Bristow, Sensory Impairment Policy Lead for Association of Directors of Adult Social Services (ADASS) I am very pleased to welcome the publication by RNIB of this new good practice guide. It builds on Progress in Sight, which has been an important tool, used by many social services departments to turn around their services for blind and partially sighted people. Much has been achieved, yet much more needs to be done to ensure that good services are available to everyone who needs them. Earlier this year, we were pleased to support the development and adoption of the UK Vision Strategy which sets out our ambition for delivering excellent support to people with a visual impairment. The task that now faces us is turning that ambition into reality in a way that promotes independence, real choice and control for those who use services. I would therefore encourage anyone commissioning or providing services for people of working age with sight loss or for older people, to use this guide as a tool to assist with the review of current services and identify areas for improvement.

Introduction This guide is designed to help local authorities and their adult social services departments in England provide high quality services that meet the needs of blind and partially sighted adults. The main focus is on services provided or commissioned by adult social services departments but the guide also recognises the important links to those health services that ensure people with sight-threatening conditions experience a smooth journey from diagnosis to independent living support [footnote 1]. Good Practice in Sight explains what needs to be done to achieve a number of key outcomes and how this fits in with local authorities' performance targets. The implementation of good practice as described in this guide will make a major contribution to implementing two key elements of the UK Vision Strategy that was launched in April 2008 [footnote 2]. This strategy has been developed by a wide range of individuals from across health and social care bodies, voluntary organisations, service users and professional groups, including the Association of Directors of Adult Social Services (ADASS). Two of the three key outcomes of the Strategy relate to people who have lost their sight and efforts that should be made to support them to live as independently as possible: 1. Eliminating avoidable sight loss and delivering excellent support for

people with sight loss. 2. Inclusion, participation and independence for people with sight loss. The Strategy calls for fair and equitable access to sight loss services and more specifically for the person-centred delivery of excellent services and support in the most appropriate way for each individual. The recommendations in this guide have been strongly influenced by RNIB's own experience in the field. However, we decided that it was important to support these recommendations with some "real life" good practice examples. There are many examples of good practice

across England, sometimes covering all areas of service provision from referral to multi-agency working, sometimes working to a particularly high standard in one or two areas. Based on our knowledge of the sector and informal discussions with stakeholders we selected six local authorities in England where we conducted semi-structured, face-to-face and focus group interviews with local authority representatives and service users to identify good practice examples for this guide. The local authorities were Camden, Derby, Gateshead, Kent, Norfolk and Sandwell and in total we interviewed 16 local authority representatives and 51 service users. The interviews were structured around nine themes: emotional support; referral process; assessment of needs; information and advice; equipment provision; training in use of equipment; user involvement; complaints procedures and inter-agency working. The choice of themes was based on: • Progress in Sight (national standards of social care for visually

impaired adults) [footnote 3]. • The recommended standards for low vision services commissioned

by the Department of Health [footnote 4]. • Previous work on the low vision services survey carried out by RNIB

on behalf of the AMD Alliance UK in 2004/5 [footnote 5], • Feedback from discussions with service users during pilots of the

interview schedule. We focused in particular on how well involved and informed users felt about the development and delivery of services. This user-centred approach is in line with Government policy as outlined in the White Paper, Our Health, Our Care, Our Say [footnote 6]. It is important to note that although many local authorities and social services departments implemented Progress in Sight, it no longer reflects the current performance framework. This good practice guide therefore seeks to build on the achievements of that document. It aims to move it forward by focusing on a number of key aspects of service delivery and placing these within the current regulatory framework. Importantly, it identifies the building blocks of a good service that will help to enable local authorities and social services to perform well in relation to the key indicators that they are measured against.

The provision of services for blind and partially sighted people cannot be considered in isolation. Many people with sight loss may also have other needs that may require support through social care services. A learning disability, hearing loss or mental health issue will inevitably lead to more complex needs and challenges. This guide concentrates primarily on the needs of blind and partially sighted people. However, social services departments should not under-estimate the importance of taking holistic, person-centred approaches to their service provision when considering the good practice promoted here. With this in mind, more good practice examples, provided by the ADASS Sensory Services sub-Group, are available on the Vision 2020 website. These examples include good practice regarding people with dual sensory impairment as well as blind and partially sighted people with learning disabilities. (For more information visit www.vision2020uk.org.uk). Setting the scene Two million people in the UK are living with sight loss. This can range from difficulties reading a newspaper, driving and recognising a friend across the room to blindness that makes it difficult to cook, look after personal hygiene or leave the house without assistance. The challenges faced by blind and partially sighted people are numerous. In addition to the problems with daily living skills mentioned above, blind and partially sighted people are constantly confronted with barriers that prevent them from participating in society on an equal footing with their sighted peers. The education system, the workplace, housing, health and leisure are all areas where blind and partially sighted people struggle to access services and play an active role. Local authorities need to take on a leadership role to ensure that strategic planning and commissioning takes account of the needs of blind and partially sighted people so that the existing barriers can be dismantled. Local area agreements delivered through local strategic partnerships and health and well-being partnership boards will be instrumental in reaching the wider goals of an inclusive society that empowers blind and partially sighted people.

By the age of 60, one person in 12 can expect to have some degree of sight loss - this rises to one in eight by the age of 75 and one in four by the age of 80 [footnote 7]. The number of people aged 60 and over is predicted to increase by 53 per cent in the next 25 years [footnote 8]. In March 2006, 307,000 people in England were registered as severely sight impaired (blind) or sight impaired (partially sighted). This equates to approximately 6,140 blind and partially sighted people per one million; 2,450 per 400,000; or 1,225 per 200,000 populations. However, the number of blind and partially sighted people is likely to be higher. New registrations have dropped significantly, a reduction that, given current population trends, cannot be explained by a decrease in the number of eligible people. In addition, under- registration overall may be as high as 20 per cent. The current registration figures are therefore not likely to reflect the magnitude of the challenge faced by social services, particularly if we look at the increasing number of older people who are at a high risk of sight loss and in need of adequate support. Important steps have been taken in the past ten years to respond to the challenges of a growing population of people with sight loss. The NHS Eyecare Pathways were developed to help commissioners and providers deliver services in line with wider objectives such as those found in the National Service Framework for Older People; Choosing Health; Our Health, Our Care, Our Say; and Opportunity Age. Fair Access to Care Services has had a major impact on the level of support provided by local authorities. However, financial pressures on local authorities have led to a tightening of the criteria against which users or potential users are assessed as to their eligibility for social care. Currently 73 per cent of local authorities in England only provide services for people whose needs fall into the top two bands of need, "critical" or "substantial" [footnote 9]. This is a worrying trend, especially when there is widespread concern that the impact of needs arising from sensory loss is often missed or underestimated by mainstream or generic practitioners. There is no doubt that many more blind and partially sighted people should have their needs considered critical or substantial.

These are major challenges but we believe that good services that meet the needs of blind and partially sighted adults can be delivered under the current Fair Access to Care Services guidance and within tight budgets. Finally, the increased use of direct payments and the introduction of individual budgets; the move towards a pan-sensory approach in the delivery of services; and the increased service user focus that is at the basis of many Government policies, are likely to trigger major changes to the ways services will be delivered in future. The increased focus on self-directed care is a welcome part of the primary objective of supporting independent living. For many service users, individual budgets and direct payments represent a liberating opportunity. Of course, it is right that those who would prefer services to be organised on their behalf should continue to have that option; while for those taking up direct payments, sound advice and support must be available to help service users and carers carry out this new role effectively. Crucially, individual budgets must also be adequate and accessible. If people are screened out at the assessment stage these new and exciting possibilities will be irrelevant to them. Against this background the elements of good practice described in this guide are important if local authorities are not only to meet the needs of blind and partially sighted adults, but also to face up to the new challenges and arrangements which are being introduced over the next two to three years. Footnotes 1. The term "social services department" is used to describe a local

authority department providing adult social services, although exact organisational names and structures may vary.

2. Vision 2020 UK; UK Vision Strategy: setting the direction for eye health and sight loss services. April 2008. Available to download from RNIB's website at www.rnib.ora.uk or from the UK Vision Strategy Project Officer on UKVisionStrateav@rnib.ora.uk or

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telephone 020 7874 1308. 3. Association of Directors of Social Services (2002): Progress in

Sight: national standards of social care for visually impaired adults. 4. NHS Eyecare Services Programme (2007): recommended

standards for low vision services. 5. Lightstone, A., McLaughlan, B., Winyard, S. (2006): A Question of

Independence. RNIB. 6. Further information on the methodology used as well as a profile of

the service users and the local authorities interviewed for this guide is available on request. Please contact Barbara McLaughlan, RNIB, e-mail: bmclauahlan@rnib.orq.uk: tel: 020 7391 2302.

7. Vale, D. and Smyth, C.: Changing the Way We Think About Blindness. RNIB, 2002

8. Government Actuary's Department population projections at: www.qad.aov.uk

9. Commission for Social Care Inspection (CSCI), 2008: The State of Social Care in England 2006-07.

www.csci.ora.uk/about us/news/state of social care 2007 ne- 1 .aspx

How an excellent service for blind and partially sighted adults can help local authorities meet their own performance targets Under the New Performance Framework for local authorities and local authority partnerships, local authorities will be measured against a set of up to 35 targets that will be negotiated with central government through new local area agreements. Many of the targets are highly relevant to blind and partially sighted people who wish to play a full role in their communities. Most importantly, the section of the Framework on adult health and well-being and the section on tackling exclusion and promoting equality contain targets that local authorities can meet by providing a good service to blind and partially sighted people. This guide highlights the key elements of an excellent service and links them to relevant performance indicators. A full list of these

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indicators with clarification about the agency leading on them is included in the appendix. Since local authorities will only choose a limited number of national indicators (up to 35) as a basis for their performance assessment and since social services departments are measured against their own set of performance indicators, we have also looked at the outcome measures used by the Commission for Social Care Inspection (CSCI) to demonstrate how the elements of an excellent sight loss support service can help social services departments meet these targets. CSCI will continue to assess and regulate on the basis of the seven outcomes in Our Health, Our Care, Our Say, namely: 1. Improved health and emotional well-being 2. Improved quality of life 3. Making a positive contribution 4. Increased choice and control 5. Freedom from discrimination or harassment 6. Economic well-being 7. Maintaining personal dignity and respect. CSCI will publish one final star rating for adult social services in November 2008. Thereafter, social services' performance will be embedded within the new comprehensive area assessments (CAAs). The inspection of regulated services will continue to be expressed as outcomes against the National Minimum Standards (NMS) and CSCI will be publishing the quality ratings of these services throughout 2008. It remains to be seen whether and to what extent the inspection regime will change once CSCI is replaced by the new Care Quality Commission in 2009.

What is excellent social care? There are many elements of social care support that contribute to an excellent service. These include an appropriate assessment of needs, timely delivery of services, good information, making sure individuals are involved in the development of services, inter-agency working with an holistic approach and finally ensuring the social care package includes the right equipment and training. All of these

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elements should add up to an individual receiving the right level of independent living support. In this guide our yardstick for assessing services is whether they meet the support and care needs of blind and partially sighted people. The best services will provide all of the essential support and care that allow people to have the same life chances and opportunities as people without sight loss. What this means in practice will differ from individual to individual. For many older people the focus will be on continuing to live independently and safely in their own homes and being able to carry on with everyday activities despite the impact of their sight loss, whereas for people of working age the focus is likely to include employment retention and help with finding work. The planned move towards more self-directed support is likely to change many current features of service delivery. Individual users will become the judge of what is best for them and therefore the service that will meet their needs. However, even if the way services are funded and the agency providing them may change considerably over the coming years, the key elements of an excellent service described in this guide will remain. To illustrate what needs to be done in practice to ensure that services for blind and partially sighted people meet the above criteria we have divided our guide into nine sections: 1. Emotional support 2. Referral 3. Information and advice 4. Assessment 5. Equipment 6. Training 7. User involvement 8. Dealing with complaints 9. Inter-agency working. Each section starts with a brief presentation of relevant benchmarks based on existing standards (Progress in Sight and the Department of Health Low Vision Standards). This is followed by a paragraph that

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specifies the expected outcome for blind and partially sighted users. We then describe how this outcome links to local authority and social services performance indicators. To illustrate how each particular element of the service can be provided in practice, we give a case study identified as a good practice example from one of the areas - both from the local authority and from the user perspective. Finally, we summarise the key messages from our interviews as key learning points. Legal framework There is a wealth of legislation, regulations and guidance in the area of social care. This guide does not aim to provide detailed information about the legal framework within which commissioners of social care operate; it simply aims to provide commissioners with an indication of the legal provisions which may be relevant to the various outcomes.

Good practice benchmark 1: Emotional support Counselling and emotional support should be provided from the point at which a person is told they have visual impairment or a disease that will lead to sight loss. This includes informal emotional support (such as peer support), and clear referral routes to accessible counselling for those that need it across all age groups. The emotional impact of sight loss is increasingly being recognised as a growing number of studies have demonstrated the increased risk of depression and even suicide among blind and partially sighted people. In many cases emotional support may need to be provided in advance of the needs assessment to help relieve the fears associated with sight loss and maintain confidence as a prerequisite for successful rehabilitation. Expected outcome Service users adjust positively to their changed circumstances. Levels of depression among blind and partially sighted people are reduced significantly.

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Meeting the benchmark Confidence and emotional stability are key to allowing a blind or partially sighted person to live independently. Meeting this benchmark will help local authorities to meet the following national performance indicators (NIs):

• Nl 119 (self-reported measure of people's overall health and well-

being)

• Nl 124 (people with a long-term condition supported to be independent and in control of their condition)

• Nl 125 (achieving independence for older people through rehabilitation/intermediate care)

• Nl 136 (people supported to live independently through social services (all ages))

• Nl 139 (people over 65 who say that they receive the information, assistance and support needed to exercise choice and control to live independently)

• Nl 173 (people falling out of work and on to incapacity benefit). CSCI emphasises "safeguarding" as an area of focus in both its regulatory and service inspection work [footnote 1], Provision of emotional support should boost local authorities' performance in terms of the following CSCI outcomes: • 1 (improved health and emotional well-being)

• 2 (improved quality of life)

• 3 (making a positive contribution)

• 6 (economic well-being)

• 7 (maintaining personal dignity and respect). Legal framework According to Local Authority Circular 93(10), social services authorities are required to provide "facilities for social rehabilitation and adjustment to disability." They are also required to provide "such advice and support as may be needed for people in their own homes or elsewhere". This has been deemed to include counselling. In urgent cases, social services have the power to provide services before an assessment is completed (NHS and Community Care Act

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1990, Section 47). Case study: Emotional support - Bristol At present none of the good practice areas identified initially provides counselling by qualified counsellors. There are only a few specialist sight counselling services scattered across the UK and an independently evaluated pilot study is currently underway at Gateshead Sight Services and RNIB Low Vision Centre in London to establish a sound evidence base. We decided to include details of a project in Bristol because it was the forerunner of this project and has been running and collating data since 2000. How it works In Bristol emotional support/counselling is provided by a part-time employed counsellor (30 hours per week) as well as three volunteer counsellors who each work eight hours a week. The counsellors use a variety of counselling techniques to meet the particular needs of each individual. Counselling is delivered both within a regional centre, and also for approximately half the client base, because of co-morbidities such as dialysis, arthritis and cancer and mobility problems, within their homes. The majority of clients (56 per cent 2006/7) required brief interventions (a maximum of 12 sessions were sufficient). 38 per cent of cases required more than 12 sessions and 16 per cent required intermittent sessions to provide emotional support during crises. Clients wait on average 4.6 weeks for a home visit and 3.1 weeks for a centre appointment. Service users predominantly present with "depression", "anxiety/stress" and issues around "living/welfare". Improvements, as measured with NHS benchmarked pre- and post-counselling questionnaires, show that all clients have benefited from counselling. Importantly, counselling leads to a significant drop in the risk of suicide and self-harm among service users. In Bristol (2006/7) the risk decreased from 53 per cent at assessment to five per cent at the end of counselling. What service users say

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"I met with Sue my counsellor from Bristol RNIB at my home on 10 occasions. I was at the time going through a very bad time, and was feeling very depressed and suicidal. I was recovering from a stroke that left me with virtually no sight. When I got home people kept telling me I was so lucky to be alive, that l was doing really well, but it just felt as if I wasn't the same person any more. I kept having nightmares and feelings that were awful. I think now that it was the shock of all this happening so quickly, which made me feel that I couldn't go on. Talking to Sue was a lifeline. She was someone who seemed to understand, and helped me to sort out some of the muddy thoughts in my head. I realised that although some things had changed, there was still something of me left. I wouldn't have been able to get in to the centre, I have started to go on the bus again, and I've got a lovely young man who is helping me with 'mobility training'. I couldn't have done this feeling like I had before. I want everyone to have this opportunity. It really did make a difference to me." (Letter from female ex-counselling client). "Tell them (Department of Health) that you visiting me is a life-saver. I am not being dramatic. It reconnects me and keeps me from insanity." (Statement from current male counselling client). Case study: Peer group support - Sandwell Sandwell do not provide emotional support from trained counsellors but they do have a very good support network set up by members of the Sandwell Visual Impairment Group (SVI Group). The group meets regularly to offer support and advice to each other on a wide range of issues including government or council policy, new equipment, leisure activities etc. They also provide emotional support to each other and work very closely with Sandwell Social Services to talk with and support people newly diagnosed with sight loss. Sarah Thomas (not her real name) lost her sight to age-related macular degeneration (AMD) in her early 70s. The local authority put

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her in contact with members of the SVI Group who meet at the resource centre funded in part by Sandwell Metropolitan Borough Council. The support and advice they gave her has helped her come to terms with losing her sight. "It was great to be able to come here to the centre and to talk to ordinary people who had lost their sight. It was reassuring to know that just because I had lost my sight that my life was not over. I had been given all this information from medical people and was very scared. I didn't really understand what was happening and didn't really want to ask questions. Speaking to other people who have lost their sight has given me more confidence to talk to professionals about my needs without feeling lost in the jargon. I still get angry and down at times and frustrated at not being able to do the things with my grandchildren as I used to but it really helps to share this with other people who are going through the same things."

Key learning points from local authority and user interviews There is no doubt that emotional support is an essential element of independent living support. Service users should be able to access a broad range of support that may need to be provided, from low-level informal emotional support to peer support and cognitive behaviour therapy. Footnote 1. "Safeguarding" refers to efforts to ensure that vulnerable adults

(including those with sensory impairments) are protected from abuse and enabled to access services or support to keep themselves safe.

Good practice benchmark 2: Referral Referral to low vision and rehabilitation services should be open to either health or social care professionals or the service user themselves. Referral should not be restricted to those who have already experienced significant sight loss. Instead it should be made

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as soon as sight deterioration is detected so that appropriate action can be taken to avoid further sight loss or loss of independence. As we are moving towards increased integration of health and social care, low vision and rehabilitation services should be commissioned in a way that allows for a smooth journey from medical treatment through to social care support. This supports the shift from intervention to prevention that local authorities and health services are required to make. The option of self-referral is essential to move away from a model where registration is the only gateway into services. Expected outcome People with sight loss access services when they or the people around them (eye care professionals, GPs, family or friends) have identified the need for help and the blind or partially sighted person is ready to accept the benefits of such help.

Meeting the benchmark Meeting the benchmark on referral will help local authorities to meet: • Nl 139 (people over 65 who say that they receive the information,

assistance and support needed to exercise choice and control to live independently)

• NI132 (timeliness of social care assessment) since it is likely to increase the number of people who are assessed by social services at the most appropriate time whether or not they are registered severely sight impaired (blind) or sight impaired (partially sighted).

Effective referrals should also boost local authorities' performance against CSCI outcomes: • 1 (improved health and emotional well-being)

• 2 (improved quality of life)

• 7 (maintaining personal dignity and respect). The Gateshead example, which follows, shows the important role an eye care liaison officer can play in meeting the benchmark and

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demonstrates the importance of health and social care pooling resources to offer an optimum service. Legal framework Under Section 47 of the NHS and Community Care Act, a local authority is obliged to carry out an assessment and make a service provision decision where it appears that a person may be in need of services. The duty to assess is proactive; it is triggered by an appearance of need and is not dependent on a request. The assessment must be provided within a reasonable period of time. Therefore, as soon as a local authority becomes aware of someone who may be in need of their (low vision or rehabilitation) services they should take steps to organise the assessment.

Case study: Referral - the eye care liaison officer in Gateshead How it works Gateshead was one of the pilot areas for the introduction of new low vision pathways developed by the National Eye Care Services Steering Group set up by the Department of Health in 2002. One shortcoming of the system was identified as a lack of information/signposting to both patients and professionals. Patients found it difficult to enter the system partly because professionals often did not know what services were available locally. To address this, Gateshead introduced an eye care liaison officer or ECLO. The ECLO constitutes a link between medical professionals (ophthalmologists, optometrists, GPs), patients and agencies that provide independent living support (this can range from counselling to benefits advice to social services assessments). ECLOs ensure that patients who experience functional problems because of their sight loss are given the option to have their social care needs assessed or access low vision services even if they have not reached the level of being eligible for registration as blind or partially sighted. They provide an essential information point that service users can access whenever they feel that they need help. The Royal College of Ophthalmologists has recognised their vital role by calling on hospitals providing treatment for wet age-related

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macular degeneration (AMD) to include an ECLO in their service

delivery plans.

In the case of Gateshead there is one full-time and one part-time ECLO funded by Gateshead Primary Care Trust to cover both Gateshead and Newcastle. What service users say Mrs Bernadette McCall had noticed her eyesight deteriorating over a period of time, which prompted her to visit her GP. Her GP referred her to an ophthalmologist who confirmed her eye condition as diabetic retinopathy. As Mrs McCall's condition deteriorated she was finding her job more difficult to carry out and began to have accidents at home, scalding her arms and hands several times while preparing meals and experiencing several trips and falls while walking around her home. Mrs McCall asked her GP if there was any help available to her to prevent her from having further accidents. She was introduced to an ECLO and in Mrs McCall's own words: "it all changed from then and everything moved very quickly". The ECLO told Mrs McCall of the services and support available at Sight Service Gateshead. It was here that she learned more about her eye condition and what to expect as time went on. She was given training and equipment to help her continue to cook safely at home and advice on specialist lighting for her home has helped her to move around more safely. Mrs McCall was also given information about benefits and employment. The ECLO, working in partnership with Sight Service Gateshead, was able to provide information on getting library services, information in large print and other practical advice. She was keen to stay in her job as a home help. The ECLO told her about the support available through Access to Work. She now takes cabs to and from work when needed and this means that she does not have to rely on public transport, which had been difficult for her as she was unable to read the timetables and destinations at bus stops. As a result Mrs McCall had taken the wrong bus on several occasions causing her to be late for work. Through Access to Work she can also have someone accompany her to a home she has not visited before to help her find her way around before carrying out her tasks.

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"I didn't know there was so much equipment available to me. I can now prepare meals on my own and no longer have to worry about sell-by dates on food or burning myself. The support I received through Access to Work has meant I can keep working."

Key learning points from local authority and user interviews Successful services are based on a flexible referral system that maximises the chances that people with social care needs can enter the system as and when they need it. In this context ECLOs are an effective way to bridge the gap between health and social care.

Good practice benchmark 3: Information and advice Information is key to ensuring that service users can make informed decisions about the care they want to receive. Information needs will have to be addressed whenever they arise before or after referral to social services. Importantly, information about available services must not be limited to those registered severely sight impaired (blind) or sight impaired (partially sighted) or those who are entitled to receive care funded by social services. Instead, information should be made available to all people with sight loss even if they are not eligible for state-funded care. For blind and partially sighted people of working age it is essential that information provided includes advice on Access to Work and technology and support that are available to help them find or retain work. Access to clear information that informs service users reliably about their options will become increasingly important with the introduction of individual budgets. The provision of relevant information needs to be combined with advocacy and advice for those who find it hard to decide which services will best meet their needs. Information should be provided in a format that is appropriate to the needs of each client and should enable clients to make informed decisions about their care. "Information prescriptions" could become an effective tool for

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the provision of individually tailored information to service users. The well-being of service users and carers will also be affected by their incomes, which in turn will often depend on access to sound advice on entitlements to benefits and tax credits. This should take the form of access to a full benefit check, plus help if there is a problem. Specific arrangements should therefore be made to link service users to a competent local source of welfare rights advice and advocacy. Expected outcome Service users are able to make better-informed decisions about the services they wish to receive. Meeting the benchmark Meeting the benchmark on information and advice will help local authorities to meet: • Nl 139 (People over 65 who say that they receive the information,

assistance and support needed to exercise choice and control to live independently).

Although none of the social services adult performance indicators relates directly to the provision of information and advice, in view of the plans to increase the use of direct payments and the introduction of individual budgets this aspect of service delivery will become an ever more important element in the assessment of social care performance. Appropriate and effective information and advice should also boost local authorities' performance in term of CSCI outcomes: • 1 (improved health and emotional well-being)

• 2 (improved quality of life) • 4 (increased choice and control) • 6 (economic well-being) • 7 (maintaining personal dignity and respect).

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Legal framework Under Section 1(2) of the Chronically Sick and Disabled Persons Act 1970, local authorities are under a duty to publish information about the services they provide. The Disability Discrimination Act 1995 requires service providers to provide information in an alternative format where this would enable or facilitate access to the information by a blind or partially sighted person. This would apply not only to general information produced by the authority in relation to their services but also to individual correspondence, care plans etc. According to Local Authority Circular 93(10), social services authorities are required to provide "such advice and support as may be needed for people in their own homes or elsewhere". In at least one recent complaint investigation it was agreed that this includes welfare rights advice.

Case study: Information and advice - Kent How it works Kent Association for the Blind (KAB) provides a large range of information including information about eye conditions, equipment, benefits, support groups and the type of ongoing support service users can expect from social services. This information is always provided in the service user's preferred format (braille, large print or tape). While the budget for information comes from a central resource for leaflets and information the extra time taken to produce braille or large print is calculated in additional staff time taken to produce the accessible materials. What service users say Judith Grange was very concerned when she began losing her sight seven years ago. She was in her mid 60s and found it very hard to deal with the thought of losing her sight. She had been diagnosed with age-related macular degeneration (AMD) and just refused to accept the diagnosis. Her husband became more and more concerned about her as she was finding it more difficult to cope and had stopped going outside the home. It was he who contacted Kent Association for the Blind for information. He was able to find out more

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information on his wife's condition and the sort of help and support available. Judith Grange was able to listen to all the information provided by KAB on cassette. "I wouldn't admit it at the time that I was finding reading very difficult as I couldn't see well enough. Listening to the information was so easy and I could listen on my own and then decide what help I might need at home." It is a priority for KAB to give people information in their preferred format. They produce information on eye conditions, social care support, training, equipment, benefits, employment help etc and they also provide information from other sources such as RNIB, Guide Dogs and other local societies. "It is really important to find out everything you can about the help and support which is available. I have learned so much because I know I can get all the information I need in a format that suits me. I feel so much more confident about asking for things now as I know I am entitled to them."

Key learning points from local authority and user interviews Service users felt that the provision of information prior to the assessment, in their preferred format, allowed them to play an active part in the assessment process. Because they knew what to expect they were able to answer questions that they might otherwise have found difficult to discuss. In addition, a wide range of information provided to users in their preferred format ahead of their assessment will maximise the likelihood that users make the right choices and their needs are met.

Good practice benchmark 4: Assessment Low vision and rehabilitation services should be based on the needs of the service user and should be flexible enough to meet any additional needs such as dual sensory impairments and mobility needs. Service users should be involved in every aspect of their assessment through the proper provision of accessible information on the assessment process and on the support options available to them as well as details of waiting times. Importantly, under the National

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Service Framework for Older People, older people should be given a single assessment of their health and social care needs to avoid duplication and ensure that the person being assessed does not have to tell his or her story more than once. While in some instances the entire assessment will be done by one professional the need for specialist assessment must remain an option. This holistic approach ensures that all of the needs of each individual can be addressed. There are also special requirements in relation to deafblind adults which require assessments to be carried out by appropriately trained individuals/teams. There should be a single point of access for individuals to contact for any additional information. The best professional to provide different aspects of the service will vary. What is essential is for specialist knowledge in visual impairment to inform the assessment even if the overall needs of an individual with multiple disabilities or long-term conditions are assessed by a generic rehabilitation worker. Where patients are offered and accept the option of registration as sight impaired or severely sight impaired, CSCI expects their assessment to start within 48 hours of the first contact with social services and for it to be completed within four weeks (70 per cent of assessments must be completed within two weeks). Expected outcome Blind and partially sighted people receive an assessment which correctly identifies their needs and translates into services that maximise independence, choice and control. Meeting the benchmark Meeting the benchmark on Assessment will help local authorities to meet: • Nl 132, on the timeliness of assessment • Nl 133, on the timeliness of social care packages. Effective and appropriate assessment policies and practices should also boost local authorities' performance against CSCI outcomes:

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• 1 (improved health and emotional well-being) • 2 (improved quality of life) • 7 (maintaining personal dignity and respect). Legal framework The legal duty to assess is set out in Section 47 of the NHS and Community Care Act 1990. This includes the requirement to undertake the assessment within a reasonable period of time (which will depend on the individual circumstances of the case) and to involve health and housing agencies where the individual appears to have such need. Guidance on the assessment process is provided within Fair Access to Care Services. This requires assessment to be amongst other things: • proportionate to the individual's presenting needs and

circumstances which may include specialist assessment of particular needs

• person-centred, recognising that individuals are the experts in their own conditions and that the use of advocates or supporters can be critical

• co-ordinated and integrated across agencies so as to produce a consistent and timely process

• inclusive of risk assessments.

Case study: Timeliness of assessment - Norfolk How it

works

Norfolk was the only local authority out of the six that we worked with that met this benchmark. This may be partly due to the fact that they have a dedicated team of eight staff - five social workers and three rehabilitation officers - who deliver services to blind and partially sighted people throughout Norfolk. This level of resourcing allows them to turn around certifications of visual impairment more quickly than other social services departments. When Certificates of Visual Impairment arrive from a hospital eye department they are immediately referred to the visual impairment expert in the sensory impairment team. Contact with the service user is made within 24 hours and a case worker is assigned who sees the

service user within four to six weeks. What service users say John Davies (not his real name) is 78 and a widower who was registered blind in 2001 as a result of AMD. He was contacted by a social worker the day after the ophthalmologist sent through his Certificate of Visual Impairment (CVI) to Norfolk Social Services. A social worker from the visual impairment team called within 24 hours to arrange a visit to Mr Davies' home for an assessment of his social care needs. A rehabilitation officer went to see Mr Davies within three weeks of the initial telephone call. Mr Davies was given an explanation of the assessment procedure and the rehabilitation officer discussed with him some of the difficulties he was having around the home as a result of his sight loss. He was initially assessed as needing practical help in the home to prepare meals and help with housekeeping. He was also assessed as requiring training on how to use various items of equipment to help with daily living tasks such as cooking and reading. "It was good to have someone to talk with as I wasn't sure how I was going to cope at home as my sight got worse." Mr Davies was given equipment to help in the kitchen and, with the help of mobility training, he was able to get around the home more safely and gradually felt more confident about going outside the home on his own. He was also given information about the local society who could help by providing him with further information and would give him the chance to meet other people with sight loss. "I wasn't sure at the time what sort of help I needed when I was first diagnosed but having someone to talk to so soon afterwards was great as I was still a bit shell-shocked. Since my wife died, I have had to get more help around the house. The social workers and the rehabilitation officer were really good at sorting me out. Since my first assessment I have had lots more support and training and now I know what works for me and what doesn't. It took a while to learn all the ropes but I know how important it was for me to get that early help as some of my friends with sight loss had to wait a long time before getting any help and they don't find it as easy to cope as I do."

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Key learning points from local authority and user

interviews Service users were most satisfied with the service they received where they were given a point of contact for further questions, allowing them to reflect on the assessment and seek clarification and further advice if needed.

Good practice benchmark 5: Equipment Specialist equipment such as low vision, mobility and reading aids and home adaptations should be provided in order to maximise the independence of service users. All blind and partially sighted people should be entitled to a minimum level of basic equipment. Equipment provided should include items which enable people to access vital information (eg medication, correspondence, food labels etc). Such items include video magnifiers, DAISY information players, and electronic scanning devices. Good overall and task lighting and materials for labelling items such as food packaging are also essential to everyday well-being and the prevention of falls and problems arising from misidentifying the contents of tins and packets. More sophisticated equipment should also be provided which enables people to maintain communication with others and know what is happening in the community. This will include computer hardware and software For people of working age it is particularly important that their equipment needs are met through Access to Work to ensure that they maximise their chances of gaining or retaining employment. Expected outcome Blind and partially sighted people receive the equipment they need to support daily living, communication and mobility. Meeting the benchmark Meeting the benchmark on equipment will help local authorities to meet: • Nl 119 (self-reported measure of people's overall health and well-

being)

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• Nl 124 (people with a long-term condition supported to be independent and in control of their condition)

• NI136 (people supported to live independently through social

services) • Nl 151 (overall employment rate) • Nl 173 (people falling out of work and on to incapacity benefits). The efficiency and effectiveness of equipment provision should also boost local authorities' performance against CSCI outcomes:

• 1 (improved health and emotional well-being)

• 2 (improved quality of life)

• 3 (making a positive contribution)

• 4 (increased choice and control)

• 6 (economic well-being)

• 7 (maintaining personal dignity and respect). Legal framework The duty of social services departments to provide equipment is covered within Section 2 of the Chronically Sick and Disabled Persons Act 1970. This requires the provision of "additional facilities" designed to secure the disabled person's greater safety, comfort or convenience. Guidance on the provision of community equipment is provided in Community Equipment Services LAC (2001)13. This states that community equipment includes (but is not limited to) "ancillary equipment for people with sensory impairment such as liquid level indicators..." The National Service Framework for Older People states at para 2.48 that: "Services should take a preventative approach, recognising that effective equipment provision ...is likely to: • help older people maintain their independence and live at home • slow down deterioration in function and consequent loss of

confidence and self esteem • prevent accidents...

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Services should be timely and resolve the frequently long delays which inhibit...their confidence and safety in coping at home."

Case study: Provision of equipment - Kent How it works Kent Association for the Blind (KAB) has long been recognised as providing a very good equipment service. They are a member of the Improving Lives Coalition, which campaigns for better social care provision for blind and partially sighted people. A wide range of equipment is available. For more expensive pieces of equipment, eg computers and text readers, KAB will provide finance through their charitable funds and many service users have benefited from the grants provided for this purpose. KAB has five resource centres spread around the county where individuals can go and look at the equipment. A member of staff is always on hand to give a demonstration of any equipment whether the user's interest is in low vision aids, kitchen items or more technical equipment such as computers or magnifiers. Having had a demonstration of the equipment, users are then in a better position to decide whether it is right for them. These resource centres also hold information about products which are not on display. Kent is a case where service users are very happy with the equipment they receive. However, since this is an instance where the local society (KAB) subsidises the provision of more expensive equipment, Kent will not be seen as a model by all. Local authorities should assess how they can provide equipment that goes over and above the usual range of magnifiers and white canes. Where they cannot increase their funding to include more expensive equipment such as electronic scanners, CCTVs and computer reading software they need to find other ways of providing access to new technologies. What service users say Ken Jones (not his real name) had always been very active in his local community and was involved in many local community groups. As Ken's sight started to deteriorate he found it increasingly difficult to continue to play his role within these groups as reading became a

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major problem. At his local resource centre he had been given a demonstration of the range of magnifiers and the various computer software packages available to help with reading text. Ken realised this type of equipment would help him to communicate better and be able to contribute more fully in his community again. Through KAB Ken was given training on using voice-activated software and was given a grant towards purchasing his own PC for use at home. "Having access to a computer means I can keep up-to-date with things and I feel I am playing my part in the community. I can read newspapers again through my PC and I can keep in touch with friends and family through my email. I would never have thought of getting a computer before I lost my sight but now I couldn't be without it. It is very expensive and 1 don't think I could have afforded one myself so getting the grant from KAB was great." RNIB carried out a survey of 500 service users' equipment needs in 2005 and found that less than three per cent had received CCTVs or other IT equipment through their local authority. Such equipment is prohibitively expensive for many people with sight loss, who, more often than not, live on low incomes. "The equipment I have been given is vital in helping me keep in touch with friends and I feel much more up to date with what is happening in the area." People with sight loss often feel cut off from their community and unable to keep abreast of local news and developments. The improved communication offered by a PC can help alleviate the loneliness and isolation felt by many with sight loss, especially those living in more rural areas.

Key learning points from local authority and user interviews Excellent services that stand out provide more than the minimum range of equipment and home adaptations. The need for more sophisticated equipment can be met by allowing its use in resource centres or by offering grants to help with its purchase. Service users should not depend on voluntary organisations for the provision of

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such grants. Despite the Government's policy to promote integrated equipment stores, service user satisfaction with the equipment received does not appear to depend on the way the equipment is delivered. The provision of information about technological advances and service auditing need to be among the key elements of the equipment service. Importantly, any move towards a retail market model needs to ensure that minimum standards of service provision are guaranteed and that service providers outside the direct control of local authorities are monitored adequately.

Good practice benchmark 6: Training Training in the proper use of aids and equipment is essential to ensure that users gain maximum benefit from the equipment provided. The provision of training in orientation and mobility, independent living and communication skills, and low vision enhancement should be part of a multidisciplinary rehabilitation programme. Expected outcome Blind and partially sighted people live safer and more independent lives. Meeting the benchmark It is important to acknowledge that in some areas of the country it may be difficult to recruit trained professionals as they are in short supply. However, providing adequate and appropriate training will help local authorities to meet: • Nl 119 (self-reported measure of people's overall health and well-

being) • Nl 136 (people supported to live independently through social

services (all ages)) • Nl 141 (number of vulnerable people achieving independent living).

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High quality and effective training provision should also boost local authorities' performance in relation to CSCI outcomes:

• 1 (improved health and emotional well-being)

• 2 (improved quality of life)

• 3 (making a positive contribution)

• 4 (increased choice and control)

• 6 (economic well-being)

• 7 (maintaining personal dignity and respect). Legal framework According to Local Authority Circular 93(10), social services authorities are required to provide, whether at centres or elsewhere, facilities for social rehabilitation and adjustment to disability (Appendix 2 para 2(1 )(a)).

Case study: Training - Kent How it works Kent Association for the Blind (KAB) takes the need for training seriously. Here, tuition in daily living and communication skills can be included in care packages in addition to training in the use of equipment and mobility training. Training is provided as often as necessary in one of the five resource centres spread throughout the county. Training can also be provided at people's homes, their workplace or wherever they feel that mobility or other training is necessary. What service users say John Gillen has been using services from KAB for seven years since losing his sight in his early 60s due to diabetic retinopathy. He has received a great deal of training over that time. "When ! was first registered I was completely at a loss about what l was going to do. I didn't know any blind people and I thought I would never be able to cope. I was frightened about what I was going to do with myself and wondered whether I would be able to do anything at

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all for myself and I hated the thought of being stuck at home. KAB has given me a lot of support and training. Early on I received some training on using a long cane and learned how to get around my home and the area I live safely. I found it all very hard especially walking around busy areas with lots of people and traffic but my rehab officer was very patient. Using public transport again was very confusing. I hadn't used a bus for years but my sight loss meant I couldn't drive anymore. It wasn't long before I felt confident enough to walk around town on my own and gradually I got to learn different bus routes and can get around very well now. Training on cooking and doing housework and laundry was also difficult. I had never known how to cook or even use a washing machine as my wife did all those things but my rehabilitation officer encouraged me to learn how to do these tasks safely by myself. I have learned lots of new things too. I use the library much more as they have a CCTV and I can now read newspapers and keep up-to- date with what is going on. Reading has become much more important to me and I love my talking books. I have also learned how to use a computer and use the internet a lot and emails. It has been a great way of keeping in touch with people and finding out information. I am not sure I would have used a computer if I hadn't lost my sight as I found them all a bit scary. KAB gave me training with using a computer. I was also able to speak to other people who had lost their sight and it was great to find out what sort of training and skills they had been given and we share a lot of our experiences and help each other."

Key learning points from local authority and user interviews With appropriate training and encouragement people with sight loss can move beyond the primary objective of allowing them to continue to pursue the activities they carried out before losing their sight. They can learn new activities that will give them increased confidence, which in turn will help them to cope better with their sight loss allowing them to make an active contribution to their community and the economy.

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Good practice benchmark 7: User involvement An important way of ensuring that services meet the needs of the people they are meant for is user involvement in setting up and monitoring services. Users should participate in agreements on setting up and implementing pathways and protocols for the delivery of low vision and rehabilitation services. In addition, service user opinions should be actively sought where audits are carried out to monitor and evaluate services and decide on necessary improvements. Expected outcome Service users are empowered to decide on the contents of their own individual care package. They play a key role in deciding what services are provided and how they are delivered. Meeting the benchmark Meeting the benchmark on user involvement will help local authorities to meet: • NI127 (self-reported experience of social care users) • Nl 128 (user-reported measure of respect and dignity in their

treatment) • Nl 130 (social care clients receiving self-directed support) • Nl 139 (people over 65 who say that they receive the information,

assistance and support needed to exercise choice and control to live independently).

User involvement should also boost local authorities' performance against CSCI outcomes: • 4 (increased choice and control) • 7 (maintaining personal dignity and respect). When inspecting social services, CSCI seek evidence of the quality and range of help on offer for people with sight loss. Such evidence could be provided through partnership boards, surveys, varied

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consultation, and good contract monitoring. Social services need to demonstrate that they use this evidence to inform commissioning intentions and activities and that it is linked to improved management performance. When monitoring local arrangements CSCI may look • visual impairment champions in social care services, possibly linked

to statutory council-wide Disability Equality Schemes (see below) • promotion of current registers as an efficient route to systematic

communication with visually impaired people • community outreach projects to any large local black and ethnic

minority (BME) groups with higher risk of visual impairments (African and African/Caribbean as well as South East Asian groups)

• promotion of one-stop-shop approaches. In addition, local authorities are increasingly likely to be judged against their performance in meeting the user consultation provisions of the Local Government and Public Involvement in Health Act 2007 (see below). Legal framework Under the Local Government and Public Involvement in Health Act 2007, local authorities are required to take steps to establish local involvement networks (LINks). The purpose of LINks is to encourage and support people to get involved in how care services are planned and run. They are empowered to make reports and recommendations and ask for information from commissioners and get a reply within a set amount of time. LINks should be in place in each local authority area from April 2008. The Disability Discrimination Act (DDA) 2005 has introduced a duty on public authorities, including local authorities, to promote disability equality. This includes promoting the participation of disabled people in public life. This would include promoting the participation of disabled people in user groups and advisory bodies etc. Under the provision of the DDA 2005, local authorities are required to draw up disability equality schemes (DES) which outline the steps the

35

authority intends to take to meet the general duty. Under the DDA, local authorities are specifically required to involve disabled people in the development of the DES. Case study: User involvement - Sandwell How it works Sandwell Metropolitan Borough Council (MBC) were one of thirteen volunteer local authorities who signed up to the Improving Lives: Raising Standards project that ran from 2003 to 2005 and which encouraged implementation of Progress in Sight. A group of service users was formed to help audit Sandwell's performance against the 16 standards for services to blind and partially sighted adults in the borough. A facilitator undertook capacity building work with the group to build their skills and confidence and enable them to engage in a meaningful way with local planners. Sandwell MBC has in recent years established very good links with Sandwell Visual Impairment Group and work closely with them to ensure the standards set out in Progress in Sight are implemented and adhered to. Representatives from the group meet five times a year with the social services team to discuss planning future services and the impact on service users. What service users say Service users feel well informed on the services they receive in Sandwell. Michael Kelly has been involved with the Sandwell VI Group since it began in 2003. "When I first got involved in meetings with social services I found it all very confusing and didn't understand the budgets, jargon and different laws on social care. I was really lost in it all, but we have gradually come to understand how the system works and understand more about how to get the best out of the services they provide. It is not perfect here and there are lots of services we would like more of, such as money for IT equipment. Nonetheless, we are informed and have our own say. I am involved in recruiting new staff and

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working with them on developing better services and it is so good to be listened to and know that you are helping to make services better. I have also been able to help in producing leaflets which give advice to people with sight loss. This has been really great as there was nothing available to me when I lost my sight and it was all very confusing and traumatic. I have met several people from around the country who don't get any say at all in the services they receive and 1 know that we are lucky to have this influence. There are disagreements on service provision and the lack of money available is an issue, but at least I get to have my say on what I think is best for me and others in my situation. I understand a lot more of the pressures that the staff are under and working with the other members of the Sandwell VI Group we have been involved in campaigning to put pressure on government to put more money into services for blind and partially sighted people. We also work with other disability groups and learn from each other on what works best."

Key learning points from local authority and user interviews User involvement should be at the heart of service development and delivery. However, to be meaningful it needs to be consistent and all service users need to feel that their input is valued. User involvement only makes sense if service providers are prepared to act on the advice they receive, and demonstrate clearly that they do so.

Good practice benchmark 8: Dealing with complaints Service users should be made aware of procedures for dealing with complaints and service providers should ensure that staff are able to deal effectively with any problems occurring. This is in line with the Government's new framework for complaints arrangements under the new health and social care complaints procedures published in February 2008 (and due to come in to force during 2009) [Footnote 1]. The new approach to complaints proposed by the Government aims to introduce:

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• An integrated complaints system that covers both health and social care.

• A system that is more flexible than previous arrangements, with agencies working with the complainant to put things right.

• A simplified, easier to understand system that is "person-centred and comprehensive" and allows disputes or complaints to be solved locally.

To meet the needs of blind and partially sighted people in this context, and ensure equitable access to complaints procedures, information about these procedures and any written information provided throughout a complaint will have to be provided in the service user's preferred format (braille, large print, audio or online). Expected outcome Blind and partially sighted users will have confidence that they have the same access to complaints procedures as sighted service users, that any problems they may have will be taken seriously and that set procedures will be followed to resolve them. Problems are solved at the earliest possible stage and as a result service users have a positive view of the service. Where a complainant has exhausted the statutory complaints procedure they are aware that they may consider a complaint to the Local Government Ombudsman. Meeting the benchmark Clear complaints procedures that service users are encouraged to invoke if necessary, as well as a swift and efficient response to a user's changed needs, will help local authorities to meet: • Nl 127 (self-reported experience of social care users) • Nl 128 (user-reported measure of respect and dignity in their

treatment) • Nl 140 (fair treatment by local services). Effective complaints procedures and processes, and timely and appropriate responses to changes in people's needs, should boost local authorities' performance in relation to CSCI outcomes: • 4 (increased choice and control)

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• 5 (freedom from discrimination or harassment) • 7 (maintaining personal dignity and respect). Legal framework The Local Authority Social Services Complaints (England) Regulations 2006 set out, amongst other things, the structure and key timescales of local authority complaints systems with three distinct stages: stage 1 (local resolution), stage 2 (investigation) and stage 3 (review panel).

Case study: Complaints and responding to changed needs - Derby In Derby the local authority is committed to resolving complaints through informal discussion. The case study below provides an example of how this works in practice. Mary Foster has been receiving social care support for 12 years since she lost her sight in a car accident. Four years ago she complained about the level of care she was receiving from care staff. Staff were meant to come to her home for one hour a day, five days a week, to help with food preparation and household tasks. Care staff were not sticking to the times agreed in the care plan, there were many different people providing the support and often staff were too busy and didn't have time to carry out the tasks Mary was assessed as needing. Mary contacted the sensory impairment team to complain about this and it was agreed that a social worker would come and meet with her to discuss her complaint. During the meeting it became clear that the agency staff employed by the local authority were understaffed and it was established that as a result Mary was not receiving the amount of care agreed in her care plan. Her social worker suggested she try direct payments, whereby she could employ her own care staff with a direct payment provided by the local authority. Mary was concerned about managing the finances of direct payments and sorting out wages for staff and security checks. Her social worker put her in contact with a local Centre for Independent Living and they helped her understand the direct payment process and gave her advice about employing

39

someone and managing her direct payments. What service users say "I was getting more and more upset about the level of support I was receiving and I was concerned about making a complaint in case I was left with no support at home. My social worker was very good and listened to me and explained to me the reasons why my care plan was not being met. Everything was arranged very quickly and the arrangements for my support are working really well now and I feel more in control. I know that if I have more problems that I can contact social services at any time and they are always willing to listen to me and help to sort things out."

Key learning points from local authority and user surveys In all areas that we worked with, all or some of the service users were aware of the complaints procedures. Those who had experienced problems felt that they had been dealt with satisfactorily by staff in the sensory team without recourse to the formal complaints procedure. Clear complaints procedures and mechanisms that ensure that service users are aware of them and are encouraged to use them are essential for a good service. Local authorities must appreciate the role of complaints procedures in improving service provision and performance. The earlier in the process that the complaint can be resolved, the better. Footnote 1. Making Experiences Count: the proposed new arrangements for

handling health and social care complaints http://www.dh.aov.uk/en/Publicationsandstatistics/Publications/Pu blicationsPolicvAndGuidance/DH 082714

Good practice benchmark 9: Inter-agency working Inter-agency working should be a key element of the design of services for blind and partially sighted people. Services should reflect a multi-disciplinary, multi-agency approach establishing formal and

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informal links with other health and social care and voluntary sector providers in the area. For adults of working age inter-agency working also requires links with Jobcentre Plus. Expected outcome Service users benefit from a comprehensive range of services that meet their individual needs. Individual professionals/practitioners and organisations improve their understanding of other service providers. Meeting the benchmark Effective and relevant inter-agency working will help local authorities to meet all of the demands of all of the national indicators highlighted in this guide. Similarly, good inter-agency working is also likely to boost local authorities' performance with respect to all of the Our Health, Our Care, Our Say outcomes. Legal framework Under Section 47(3) of the NHS and Community Care Act 1990, the local authority is obliged to invite health and housing services to participate in the assessment process and service provision decision if it appears that the individual has health or housing needs. Case study: Inter-agency working - Gateshead How it works In Gateshead, multi-agency working is an essential part of the new low vision service. The local authority has links with counsellors, local societies, ophthalmologists, opticians/optometrists, employment advisers, specialist teachers, GPs, Low Vision Services Committees and other disability services (eg for people with learning disabilities, dual sensory disabilities, or mobility problems). The links with counsellors and GPs are informal (ie non-written) whereas those with ophthalmologists, opticians/optometrists and employment advisers are formal (ie based on a written protocol) and those with local societies, specialist teachers, other disability services and the local Low Vision Services Committee are both formal and informal.

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It is possible that this high level of inter-agency working is influenced by the existence of a Low Vision Services Committee in the area whose meetings are regularly attended by the local authority. Key learning point from local authority survey Since multi-agency working is a key feature of all good practice areas included in this guide it is an approach that should be emulated by local authorities aiming to improve their services.

Appendix: National indicators under the new performance framework for local authorities and local authority partnerships The most important national indicators are: NI119: Self-reported measure of people's overall health and well- being. Comment: The local authority or local partner already provides the data; data collection is proposed through the new Place Survey, which is subject to consultation. Nl 124: People with a long-term condition supported to be independent and in control of their condition. Comment: Primarily the responsibility of the PCT (data is to be collected via the Healthcare Commission Primary Care Trust patient survey), but the Council's Overview and Scrutiny Committee (O&S Committee), at the very least, should take some degree of "ownership". Nl 125: Achieving independence for older people through rehabilitation/intermediate care. Comment: This indicator "captures" the joint work of social sen/ices and health staff, and services commissioned by joint teams; the precise allocation of responsibilities will be subject to the configuration of local arrangements. Nl 127: Self-reported experience of social care users. Comment: Primarily the responsibility of the local authority. Nl 128: User-reported measure of respect and dignity in their treatment. Comment: This is the responsibility of both the local

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authority and the PCT (at the time of writing the DCLG stated: "Work is ongoing with CSCI to establish the collection of this data and the regularity with which it will report.") Nl 130: Social care clients receiving self-directed support (direct payments and individual budgets). Comment: Primarily the responsibility of the local authority. Nl 132: Timeliness of social care assessment. Comment: Primarily the responsibility of the local authority.

Nl 133: Timeliness of social care packages. Comment: Primarily the responsibility of the local authority. N! 136: People supported to live independently through social services (all ages). Comment: Primarily the responsibility of the local authority. Nl 139: People over 65 who say that they receive the information, assistance and support needed to exercise choice and control to live independently. Comment: This indicator 'is designed to reflect a wider view of 'support' than simply a narrow definition of services provided by or via social services': data collection will be through the new Place Survey. Nl 140: Fair treatment by local services. Comment: Primarily the responsibility of the local authority. Nl 141: Number of vulnerable people achieving independent living. Comment: Primarily the responsibility of the local authority, and particularly the responsibility of Supporting People teams. Nl 142: Number of vulnerable people who are supported to maintain independent living. Comment: Primarily the responsibility of the local authority, and particularly the responsibility of Supporting People teams. Nl 173: People falling out of work and on to incapacity benefits. Comment: This indicator helps monitor the impact of local partnership activity: such activity may include joint working between local

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authorities, the Department for Work and Pensions, Health and Safety Executive, the NHS and employers.

Acknowledgements In compiling Good Practice in Sight, we have benefited vastly from the advice and expert knowledge of:

Anne Bristow, Association of Directors of Adult Social Services

(ADASS) Lance Clarke, National Association of Local Societies for Visually Impaired People (NALSVI) Sue Dale, RNIB Bristol Geoff Fimister, RNIB Samantha Fothergill, RNIB Carl Freeman, The Guide Dogs For the Blind Association Mike George, George and Lennard Associates Sandra Gregory, Surrey Association for Visual Impairment (SAVI) Claire Goodchild, Care Services Improvement Partnership (CSIP) Hilary Grime, Oxfordshire Social Services Sensory Impairment Team Fazilet Hadi, RNIB Laurie James, Commission for Social Care Inspection (CSCI) Andy Kaye, RNIB Linda Lennard, George and Lennard Associates Miriam Martin, Action for Blind People Keith Mastin, IRIS Centre, Crewe Mary Norowzian, RNIB Clive Palmer, Association of Directors of Adult Social Services (ADASS) Alan Rosenbach, Commission for Social Care Inspection (CSCI) Ian Salt, Care Services Improvement Partnership (CSIP) Peter West, Commission for Social Care Inspection (CSCI) Steve Winyard, RNIB. Special thanks go to Rosemary Frazer for conducting the interviews with local authorities and service users and for compiling the case studies. Author

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Barbara McLaughlan, RNIB This guide is also available in audio CD, large print and standard print. To order copies in alternative formats, please contact RNIB Customer Services. Telephone 0845 702 3153 or email cservices@rnib.org.uk © RNIB September 2008 Registered charity number 226227