Written evidence from Royal National Institute
of Blind People (RNIB) (COM 20)
SUMMARY
Key points:
— 85% of sight loss is avoidable, yet people
continue to lose their sight unnecessarily, resulting in costs
to the nation of £4.3 billion due to lower employment, informal
care costs and the cost of devices and modifications.
— More, not less needs to be spent on eye
health promotion, detection and access to treatment. Eye clinics
are struggling to meet the growing demand for treatment due to
the licensing of new treatment and the ageing of the population.
Commissioners should not be allowed to cut corners but must provide
licensed and NICE approved treatments to all patients.
— Patients whose sight cannot be saved
rarely experience a smooth journey from health to social care.
In some areas they benefit from Eye Clinic Liaison Officers that
signpost them to available support services. These are often co-funded
by Social Service departments. Cuts to Social care funding risk
jeopardising this essential resource to support independent living.
— Social services often underestimate the
support needs of blind and partially sighted people. As a result
blind and partially sighted people are often excluded from personal
budgets and receive little or now support. Further cuts to social
care funding is likely to exacerbate this situation leaving blind
and partially sighted ever more isolated and unable to lead fulfilling
lives in their communities.
— This lack of support is likely to result
in health services bearing the costs of providing treatment for
depression, falls and health problems experienced by carers.
RNIB SUBMISSION
1. As the largest organisation of blind
and partially sighted people in the UK, RNIB is pleased to have
the opportunity to respond to this consultation.
2. As a campaigning organisation of blind
and partially sighted people and leading organisation in the UK
Vision Strategy we fight for the prevention of avoidable sight
loss as well as the rights of people with sight loss in each of
the UK's countries.
3. In our submission we will focus on the
impact of cuts to Local Authority funding and the need to find
up to £20 billion savings in the NHS on the services provided
to people with sight-threatening eye disease and those who are
blind or partially sighted.
CURRENT CHALLENGES
IN THE
AREA OF
EYE CARE
SERVICES AND
THE IMPACT
OF FUNDING
CUTS
4. According to NHS Choices 85% of all sight
loss is avoidable.[27]
This is to some extent a reflection of the development of new,
effective treatments for the main cause of blindness and partial
sight in the UK—wet age-related macular degeneration. Eye
clinics across have struggled to meet the challenge of increasing
treatment capacity in line with growing demand. Despite ongoing
efforts to streamline services and patient pathways we are aware
of considerable problems around the provision of treatment for
glaucoma, access to wet AMD treatment and diabetic eye disease
and, most recently, anecdotal evidence of the imposition of tougher
criteria for cataract surgery. In addition, many patients are
denied treatment for conditions, such as central retinal vein
occlusion, which are not yet subject to NICE guidance or where
no licensed treatment is available.
5. People are losing their sight unnecessarily
and the costs to the nation are massive; in 2008 the indirect
costs of sight loss in the UK (including lower employment, informal
care costs and the cost of devices and modifications) were estimated
to have amounted to £4.3 billion.[28]
6. The challenges facing eye health care
providers at present are likely to increase further due to higher
demand as a result from the imminent licensing of new treatments
for other conditions with previously limited or no treatment options
(diabetic macular oedema, central retinal vein occlusion). The
risk is that commissioners will cut corners to reduce treatment
costs by opting for cheaper unlicensed treatment alternatives.
We are aware of at least two Primary Care Trusts who have pursued
this avenue in relation to the treatment of wet age-related macular
degeneration. RNIB continues to challenge their approach, expressing
particular concern about patient information leaflets that provide
biased and incomplete information about the unlicensed treatment
alternative. The pressure to cut costs is clearly undermining
the mandatory nature of NICE technology guidance and the effectiveness
of the current regulatory system that has been developed in the
interest of patient safety.
6. Stakeholders in eye health (including
pharmaceutical companies, the Royal College of Ophthalmologists
and patient organisations) are working on a set of recommendations
to disseminate examples of where eye clinics have managed to cope
well with the challenges they are facing.[29]
While this is likely to contribute to better commissioning of
eye health care services and increased efficiency we believe that
a higher level of sight loss prevention can only be achieved if
funding is at least sustained in real terms at the current level.
TRANSITION FROM
HEALTH TO
SOCIAL CARE
7. Good practice in eye health requires
services that allow patients to transit smoothly from health to
social care. This is essential for those who do not respond to
treatment and for those whose eye condition cannot be treated
either because there is no treatment available or because they
have presented late for treatment. At present this smooth transition
from health to social care is far from guaranteed since few PCTs
commission hospital eye clinics to provide a service to signpost
patients to available support.
8. So-called Eye Clinic Liaison Officers
(ECLOs) who provide this support have been recognised by the Royal
College of Ophthalmologists as an essential part of an effective
service for patients with age-related macular degeneration (AMD)
and in some areas ECLOs are being funded jointly by Social Services,
PCTs and third sector organisations.
9. There is growing concern that the cuts
to Social Services budgets announced by the Government will lead
to a discontinuation in the funding for these posts especially
where health and social care budgets are not integrated.
CURRENT CHALLENGES
IN THE
AREA OF
SOCIAL CARE
FOR BLIND
AND PARTIALLY
SIGHTED PEOPLE
AND THE
IMPACT OF
FUNDING CUTS
10. Even without any cuts in Social Services
budgets blind and partially sighted people are affected by the
increasing rationing of social services. In many cases their support
needs are not recognised as significant enough. They are often
assessed as having only low or moderate needs and as a result
they rarely benefit from the personalisation agenda that the Government
has rightly promoted in the past few years. Where blind and partially
sighted people have accessed personal budgets they have welcomed
the opportunity to put together a care package that meets their
needs and have seen great benefits from doing so.[30]
12. Given the current problems facing blind
and partially sighted people in relation to access to social care
the proposed funding cuts present an enormous threat to their
wellbeing. Already:
— 20% of blind and partially sighted people
say they do not recall receiving any visit from social services
in the year after they registered with Social Services.
— Services vary significantly across the
country: The percentage of people reporting that they received
a visit from social services within six weeks of being referred
to Social Services ranged from 88% for the best local authority
to 14% for the worst.
— 17% of people that register with their
council reported that they received no help or information at
all in the year following registration.[31]
13. If funding cuts are implemented across
the board this situation can only get worse.
INDIRECT IMPACT
OF SOCIAL
CARE CUTS
ON HEALTH
SPENDING
14. If social care funding is cut and more
blind and partially sighted people receive no support at all it
is likely that the fall-out from this lack of support will be
felt most acutely by carers and the health service itself.
15. This is because sight loss is associated
with an increased risk of depression[32]
and an increased risk of injurious falls[33],
[34],
[35],
[36]
and there is evidence that it also leads to extended average length
of stay in hospitals resulting in late discharge into community
care.[37]
Reduced support is likely to increase costs associated with these.
16. There is also strong evidence for the
impact of caring on carers' own health[38]
and less social care support is likely to increase that impact
and the associated costs of an increased use of healthcare resources
by carers. Society is already spending approximately £2 billion
per year on the informal care for people with sight loss. Further
reductions in social care support are likely to increase this
figure as well as the figure of £2 billion spent on the direct
costs associated with sight loss.[39]
CONCLUSIONS
17. The UK Government supports the World
Health Organisation's initiative to eliminate avoidable sight
loss by 2020 and the UK Vision Strategy that was developed to
achieve this aim. Whilst we recognize that the efficiency of eye
health services can be further improved we have little doubt that
the proposed spending cuts in social care and the decrease in
NHS funding threaten to undermine efforts to improve the eye health
of the population. Without adequate funding for early detection
and treatment the number of people with sight problems is likely
to increase from 1.8 million to almost four million in 2050. We
strongly question the merits of salami-slicing spending cuts across
all areas of NHS spending and would welcome a thorough, evidence-based
debate on priority setting that takes account of new developments
in eye health care and the impact of Social Care funding cuts
on people with sight loss and those who care for them.
October 2010
27 Available at: http://www.nhs.uk/conditions/visual-impairment/pages/introduction.aspx Back
28
Access Economics (2009): Future Sight Loss UK (1): the economic
impact of blindness and partial sight in the UK population. Available
at: www.rnib.org.uk Back
29
For a discussion of capacity issues in AMD services see: Amoaku,
W. (2009): Royal College of Ophthalmologists: Maximising Capacity
in AMD Services. available at: http://www.rcophth.ac.uk/docs/scientific/Maximising_Capacity_in_AMD_
Services_-_December_2009.pdf and Amoaku, W. (2009): AMD Services
Survey. Royal College of Ophthalmologists. Available at: http://www.rcophth.ac.uk/scientific/amd-services-survey Back
30
Kaye, A (2009): Lost and Found. RNIB, available at: www.rnib.org.uk Back
31
Douglas, G, S Pavey and C Corcoran (2008): Access to information,
services and support for people with visual impairment. Visual
Impairment Centre for Teaching and Research (VICTAR), University
of Birmingham. Please note that the figures regarding local authorities
are unweighted. Back
32
Evans, J R, Fletcher, A E and Wormald, R P (2007): Depression
and anxiety in visually impaired older people, Ophthalmology,
Volume 114, Issue 2, International Centre for Eye Health, London,
pp. 283-288 Back
33
Legood R, Scuffham P A and Cryer C (2003): "Are we blind
to injuries in the visually impaired? A review of the literature".
Journal of Visual Impairment Research Back
34
Thomas Pocklington Trust (2007): Lighting the homes of people
with sight loss: an overview of recent research Back
35
Scuffham et al. (2002): The incidence and cost of injurious falls
associated with visual impairment in the UK Back
36
Access Economics (2009): Future Sight Loss UK (1): the economic
impact of blindness and partial sight in the UK population. Available
at: www.rnib.org.uk Back
37
Morse et al. (1999): Acute care hospital utlization by patients
with a visual impairment Back
38
HM Government (2008): Carers at the heart of 21st-century families
and communities. Chapter 5: Health and Wellbeing. Available at:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_085338.pdf Back
39
Access Economics (2009). See Footnote 40. Back
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