Vision Support Services
Being there • Person centred • Self management
Contents
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Foreword
Cost of sight loss
Sight loss and falls
Sight loss and depression
Vision Support Services
Vision Support Service locations
Emotional support
Practical support
Evidence and impact
Financial savings to health and social care
Additional benefits
– Peer support
 Hidden sensory loss
– Learning disabilities and sight loss
– Dementia and sight loss
– Vision Support Services – complex needs
 References
 Interested in finding out more?
Foreword
Being there: for when people find out they are losing their
sight
John Legg, Director of RNIB Scotland says: “Imagine what it
must be like to be told that you are going to lose some or all of
your sight. What would it mean to you personally – your family,
your work, your social life?
Every day in Scotland, ten people begin to lose their vision; but
only one in six will be offered any form of emotional or practical
support.
Yet without this, people can find it very difficult to cope. They can
rapidly lose confidence, leading to social isolation, and experience
feelings of depression, anger and confusion.
RNIB Scotland is working, along with partners, to establish a
network of local Vision Support Services (VSS). These will offer
people newly diagnosed with sight loss support, both emotionally
and practically, in adjusting to their new circumstances.
We want everyone in Scotland to have the support they need to
find their lives again.”
Zac Koshy, Consultant Ophthalmologist says: “The Vision
Support Service provides a vital link at the point of diagnosis by
offering emotional and practical support. Both patients and the eye
clinic benefit immensely from the service and it ensures that
patients adjust and learn to cope with their sight loss. There has
been excellent feedback from those who have utilised the service
and I have no hesitation in recommending the VSS.”
Cost of sight loss
200,000 people currently live with sight loss in Scotland. This is set
to more than double by 2050 [1], which equates to an estimated
400,500 people. Of these 80 per cent will be over the age of 60.
In 2013 the direct costs associated with partial sight and blindness
in Scottish adults was £151.1million [1] with indirect costs equating
to £472.3million.
Summary of direct costs in millions associated with partial
sight and blindness in Scottish adults 2013:
 Hospital recurrent expenditure £44.7m
 Non-admitted expenditure £33.7m
 Prescribing expenditure* £20.6m. (*Includes the cost of
Lucentis typically used to treat age-related macular
degeneration.)
 General ophthalmic services (GOS) £32.3m
 Expenditure associated with injurious falls £1m
 Research and development £0.5m
 Residential care and community care services £13.2m
 Capital and administration £5.1m
 Total £151.1m
Sight loss and falls
Falls are a major cause of disability and the leading cause of
mortality resulting from injury in people aged over 75 in the UK [2].
The rate of falls in older people with sight loss is 1.7 times higher
than other older people of the same age, with hip fractures 1.3–1.9
times higher. We know from a large body of research that falls in
older people result from multiple risk factors. These include
increasing age, previous history of falling, gait and balance
problems, mobility limitations, fear of falling, multiple medications,
environmental or home hazards, and sight loss [2].
Almost half (47 per cent) of all falls in the population of blind and
partially sighted people are directly attributable to the sight
problem [1]. The cost to NHS of falls associated with sight loss in
Scotland is at least £1million per annum [1].
The Vision Support Service can help people overcome their fear of
falling and give advice on how to avoid falls.
Jean Robertson says “My biggest obstacle was getting out and
about, I was afraid I was going to fall which really knocked my
confidence.”
Sight loss and depression
The prevalence rates of depression in elderly populations with
sight loss are between 25 per cent and 45 per cent [1]. The relative
risk of depression is estimated to be around 3.5 times higher for
those with sight loss compared to those fully sighted [1].
Deteriorating vision can have a negative impact on lifestyle,
leading to increased anxiety and isolation. It is estimated that up to
30 per cent of those living with age-related macular degeneration
experience moderate to severe depressive symptoms due to vision
loss [3].
In 2009/10 mental health problems cost Scotland an estimated
aggregate cost of £10.7billion with the costs of health and social
care estimated at £1.9billion [4].
The Vision Support Service provides critical emotional support
freeing up clinical staff’s time. Emotional support is explained in
more detail later on.
Steven Gardyn says “I was shattered when I was diagnosed and
felt like committing suicide. I didn’t know how I was going to cope,
go outside or read letters. I was totally depressed and had turned
to alcohol to cope. The Vision Support Officer was someone who
was willing to listen to me and understood my concerns.”
Vision Support Services
The Vision Support Service provides vital emotional and practical
support to anyone newly diagnosed with sight loss and provides a
critical link between service users and support services.
Vision Support Services include:
 Service users
 Carers
 Nurses
 Orthoptists
 Optometrists
 Falls teams
 Social work services
 Family
 Rehabilitation and mobility services.
Vision Support Service locations
There are 38 major ophthalmic outpatient departments across
Scotland. In September 2014 only 36.8 per cent of these were
offering patients emotional or practical support.
Areas include:
1. Highland
2. Grampian
3. Tayside
4. Forth Valley
5. Fife
6. Lothian
7. Borders
8. Lanarkshire
9. Dumfries and Galloway
10. Ayrshire and Arran
11. Greater Glasgow and Clyde
12. Western Isles
13. Orkney
14. Shetland
Those with an RNIB service are: Ayrshire and Arran, Borders,
Edinburgh and Lothians, Shetland and Tayside.
Those with a similar service are: Grampian, and parts of Greater
Glasgow and Clyde.
Those with no service are: All the other regions.
Emotional support
Emotional support is critical for anyone newly diagnosed with sight
loss, their family or carers. All our Vision Support Officers are
skilled professionals who have undertaken the City University
accredited Eye Clinic Support Studies Course.
Emotional support includes:
 Listening
 Empathising
 Acknowledging
 Talking through worries or concerns
 Normalising.
Tom Massey had lived with sight loss from childhood but nothing
prepared him when his sight deteriorated suddenly. Tom says: “My
biggest concern was my wife had passed away and how I was
going to cope on my own. The Vision Support Service helped me
in so many ways. I felt a sense of optimism and that I would be
able to maintain my independence. I felt positive when I returned
home.”
Practical support
Practical support is also viewed as an essential element for people
living with sight loss, as well as their family or carers:
Practical support includes:
 Identification of need
 Referral to statutory and voluntary services
 Advice on safety
 General helpful hints and tips
 Links to peer support
 Information on importance of treatment compliance
 Information on eye condition
 Advice on good eye health
 Impartial information on local and national services
 Impartial advice and information on registration.
Evidence and impact
Vision Support Services collate core data on each person
supported by the service. In addition to this we effectively monitor
the impact of our emotional and practical support through service
user experience questionnaires and quarterly service user follow
up surveys.
In 2013 Vision Support Services helped over 1,150 people who
were newly diagnosed. A follow up survey of a sample of those
helped shows the impact of the outcomes observed:
 96 per cent reported better emotional wellbeing especially in
regard to reduced pessimism about the future
 92 per cent reported the meeting with VSS as “a major cause”
or “the most significant cause” of improvements in their
independence and quality of life
 88 per cent who got advice said that they felt more confident in
avoiding falls.
Jim Boal was referred to ophthalmology and then told, he could no
longer drive and was offered registration. Jim says “I was in shock
and couldn’t take it all in. My concern was how I was going to
cope. Everything felt easier after meeting the Vision Support
Officer, she took us through services that could help and even
referred me into the ones I was interested in. I would definitely
recommend the Vision Support Service.”
Financial savings to health and social care
A study [5] has been conducted by RNIB, Action for Blind People
and Cardiff Institute for the Blind, to estimate the financial value of
outcomes attributable to the Vision Support Service (known
elsewhere as ECLO). This demonstrates the financial business
case and cost effectiveness of providing early intervention and
support through the Vision Support Service.
Based on a full-time and well-established service the study
highlighted the following outcomes and savings:
Outcome: Increased emotional wellbeing
Valuation*: Cost of NHS counselling (£910)
Savings*: £95,009
Outcome: Increased independence in home
Valuation*: 12 months of social services home visits (£2,673)
Savings*: £257,080
Outcome: Reduced fear of falling
Valuation*: NHS hip fracture cost (£27,085)
Savings*: £17,840
Outcome: Reduced follow-up NHS appointments
Valuation*: Cost of two nurse appointments (£67)
Savings:* £8,009
Total savings per year £377,936
*Valuations are based on UK data. The study explains in detail the
figures used to calculate these savings.
The results of the study concluded one full-time and well
established Vision Support Service can provide savings of
£377,936 a year to health and social care budgets.
In addition to the financial savings, there are other attributable
savings, which include:
 reduced NHS follow-up appointments release nursing staff and
appointment spaces
 reduced fear of falling releases surgical and theatre staff time,
operating time, rehabilitation requirements and much more
 increased emotional wellbeing releases qualified counsellors
and appointment times as well as reducing the knock on effect
depression and mental health can have on other services such
as GPs, mental health nurses, pharmacists and prescription
costs
 increased independence in the home (equals savings to
reduced social care home visits) frees up social work
employees’ time, appointment times and can help to reduce
waiting lists. In addition to this, the Vision Support Service
screens each referral before it is sent to the social work teams,
which can also aid the social work teams when prioritising case
allocation and case management.
Return on investment
The average cost of one full-time Vision Support Service,
combining the salary, employer’s costs such as training and travel
costs, full management and delivery of the confidence building
Looking Forward programme, comes to £41,000. This equates to a
return on an investment of £9.22 for every £1 invested based on
savings of £377,936 per year.
Lynette Lusk says “I attended the optometrist because I thought I
needed new reading glasses and was devastated at the diagnosis
of two eye conditions and having to give up driving and work.”
Additional benefits
At no extra cost, the Vision Support Service offers a four-week
peer support programme to service users in the community called
Looking Forward.
Peer support
The benefits of peer support are widespread for individuals. These
include better mental health, increased sense of wellbeing and
increased confidence and learning skills.
As well as the recognised health benefits, peer support can prove
to be a worthy financial investment in the long term, resulting in
lower overall costs, fewer hospital admissions and reduced bed
days [6].
By creating a supportive environment, the Looking Forward peer
support programme allows people to talk about problems and
solutions with others who are experiencing similar difficulties.
100 per cent say they would recommend Looking Forward.
Average confidence level score before Looking Forward is 4.4
(1 = low confidence, 10 = extremely confident).
Average confidence level after Looking Forward – 8.25.
Barry Carmichael says “Since attending Looking Forward I have a
more positive outlook, I found out about support and services
available and I am now more independent and confident in getting
out and about on my own and would definitely recommend it to
others.
Hidden sensory loss
Hidden sensory loss is a term used to describe when sight loss is
not the presenting condition. Consequently sight issues may be
“masked” by the primary condition.
RNIB’s Bridge to Vision Service aims to increase awareness of the
prevalence and incidence of hidden sensory loss and to ensure
that people with learning disability, autism, dementia or stroke
have their sensory loss identified and treated in their local
community.
Vision is the key to learning, communication and movement. The
more a person can see, the easier it is for them to make sense of
their world.
RNIB has a team of Vision Support Officers who specialise in
complex needs. This team help individuals to access primary
optometric health and social care services as well as offering
emotional and practical support.
Learning disabilities and sight loss
 People with learning disabilities are 10 times more likely to have
serious sight problems and people with severe or profound
learning disabilities are most likely to have sight problems.
 People with learning disabilities may not know they have a sight
problem and may not be able to tell people.
 6 in 10 people with learning disabilities need glasses and often
need support to get used to them.
Dementia and sight loss
750,000 people have dementia in the UK, most of whom are over
65 and around 1 in 7 of the over 65s is living with significant sight
loss. By the age of 75 at least 2.5 per cent of people will have both
conditions. As the population ages, the number of people with both
dementia and sight loss will increase. In care homes, studies
indicate a higher proportion of residents may have both conditions.
Vision Support Services – complex needs
Vision Support Services – complex needs include:
 Assessment of how the person uses their vision in everyday life
 Training to carers and professionals
 Advice, information and signposting to other services
 A personalised vision passport to influence support plans
 Emotional and practical support
 Support to access community or hospital eye care services
References
1. Future of sight loss UK, 2014, RNIB
2. www.profane.co/vision-and-falls-prevention-infographic
3. Optometry Today, July 2014, www.optometrytoday.com
4. What’s it Worth Now? SAMH, 2013, www.samh.org.uk
5. Evidence and Impact Report, 2014, RNIB
6. Need2Know Briefing: Peer Support, 2012, Mental Health
Foundation
Interested in finding out more?
If you are interested in finding out more please contact:
Clare Jewell, Vision Support Services and Looking Forward
Telephone: 0782 440 9816
Email: clare.jewell@rnib.org.uk
Iain Kennedy, Vision Support Services – complex needs
Telephone: 0758 411 4641
Email: iain.kennedy@rnib.org.uk
Or alternatively contact our head office:
RNIB Scotland
12–14 Hillside Crescent
Edinburgh EH7 5EA
Telephone: 0131 652 3140
Email: rnibscotland@rnib.org.uk
Website: rnib.org.uk/scotland
RNIB is there for anyone living with sight loss.
Call our Helpline on 0303 123 9999 or email helpline@rnib.org.uk
Breathing Space is a free, confidential phone and web based
service for people in Scotland experiencing low mood, depression
or anxiety. Breathing Space and RNIB Scotland recognised the
vital link between staying connected while also supporting people
emotionally. Today emotional support is offered during working
hours through the RNIB Vision Support Service and out of hours
through the Breathing Space phoneline. Call 0800 83 85 87 or visit
breathingspacescotland.co.uk Lines are open all weekend from
6pm Friday to 6am Monday, and Monday to Thursday from 6pm to
2am.
Copyright RNIB Scotland September 2014
Registered charity number SC039316