1. The Importance of a Certificate of Vision Impairment CVI
Ian Moran
Chair Welsh Rehabilitation Officer Forum

2. Certification and Registration – What are the numbers?
Total number of people in Wales registered as:
sight impaired (SI) 7,624
severely sight impaired (SSI) 7,417
Stats Wales
Services/Disability-Registers/physicallysensorydisabledpersons-by- localauthority-disability-agerange
Total number of people newly certified ,455
Source Moorfields Eye Hospital
health-eye-care-and-hearing-statistics-april-2017-march-2018-revised.pdf

3. What is the difference between Certification and registration
Certificate is completed after a person’s vision is reduced to a certain level of visual acuity or Visual field.
This is competed and signed by a consultant ophthalmologist
Copies are sent to GP, Low vision service, Local authority, Moorfields and to the individual
Registration
Social Services and Wellbeing Act 2014 Part 2 Section 18 states:
A local authority must establish and maintain a register of the people ordinarily resident in the authority who are sight impaired or severely sight impaired
Registration is voluntary and can only be carried out once a CVI has been completed

4. What does a Certificate of Vision Impairment (CVI) actually do?
Several CVI pathways into the local authority
Certificate leads to an offer of registration within the local authority (in quite a number of circumstances this can be the first time we know about a persons vision loss). It is important to note here that a person does not have to be certified to access support from the local authority.
Gate way document into adult social care for specialist assessment to look at and identify difficulties people with a vision impairment can have.
Certification and registration can give access to many concessions (blue badge, bus passes, and TV licence reduction and welfare rights)
Informs local authority of numbers of people with sight loss to enable them to plan for future service delivery. (Low numbers of CVI’s means less Rehabilitation workers).

5. Best Practice
As in the case of the certification process, viewing registration as an administrative procedure is not helpful and may deny clients the opportunity to explore the psychological as well as the practical implications of their visual disability. The worker who undertakes the registration will need to be able to access a wide range of knowledge about services. A working knowledge of mobility and rehabilitation and terminology used in certification.
David Thomas, British Journal of Visual Impairment

6. Considerations/Impact

7. What this could mean for people with impaired vision
Discharged patients will no longer have to wait to be seen by a consultant. An example would be somebody with dry AMD
Easier access to the high street practitioners
More timely referrals for rehabilitation intervention
Can access welfare benefits sooner

8. Considerations: What certification in primary care could mean for Vision Rehabilitation services
Increased demand and waiting times – especially where there is no referral pathway from LVSW
Better rehab outcomes from earlier intervention
Earlier emotional and practical support for people whose vision is likely to deteriorate further.

9. Challenges to meet this increased need
Workforce development – At present we have 34.5 full time posts across 22 Local Authorities. A significant number of rehabilitation workers are due to retire in the next 5-10 years. We need to build on work already underway to ensure sustainability and continuity of Rehabilitation provision
We would like Welsh Government and Social Care Wales to adopt the apprenticeship standard for Vision Rehabilitation from England, so local authorities and organisations can access the Welsh apprenticeship levy
Working in partnership: Build on existing work with our partners in Health to ensure Clearer referral routes from ophthalmology and optometry into social care and the third sector for ongoing support.

10. Final thought…
“Professionals should work to the top of the skill level to free up time for others to do what only they can do”.
Gwyn Williams Eye Care Conference 2018