1. The Care Act 2014 – Implications for Statutory Visual Impairment Services Simon Labbett Rehabilitation Workers’ Professional Network October 2014

2. Main issues
Visual Impairment Rehabilitation mentioned in law for the first time
Opportunities to emphasise role of CVI
Strong safeguards for Deafblind people
Eligibility will remain contentious
Understanding how the sightloss pathway is implemented locally will be crucial to developing services

3. Children and Families Act 2014
The core offer – consider implications for local authority sensory provision in widest sense (Habilitation and Rehabilitation)
Transition arrangements will overlap with Care Act

4. Specialist assessment
Sight Loss Pathway
Referral
Accessing Services
Screening assessment
Specialist assessment
No service
Social Care Assess
Eligibility
Rehabilitation
Care Package
Social Care Assess
Rehabilitation
Eligibility
Eligibility
No Service
Reduced care package
No service
Care Package

5. General Areas of Challenge
Failure to screening at assessment level (including offering registration)
Failure to undertake adequate assessment (including comms. needs)
Failure to offer or to provide adequate rehabilitation
Failure to plan or anticipate future service needs
Failure to provide information and in accessible formats

6. Issue: people not getting through screening barrier Legal: failure to screen (in a way that anticipates obligations; failure to skill-up staff to recognise need)
6.23 LAs must ensure that every adult with an appearance of care and support needs…receives a proportionate assessment…
22.18 Upon receipt of the CVI, the LA should make contact…within two weeks to arrange inclusion on the LA’s register…Where there is appearance of need for care and support, LAs must arrange an assessment of their needs…
(CVI guidance Dept. Health: “purpose of form…if the person is not known to social services as someone with needs arising from their VI, registration also acts as a referral for a social care assessment)
6.20 LAs should not remove people from the process [of screening] too early…LAs must ensure that their staff are sufficiently trained and equipped to make the appropriate judgements needed to steer individuals towards either preventative services or a more detailed care and support assessment.

7. Implications for entering the system
Will Local Authorities need to process CVIs differently?
How will Local Authority “call-centre” staff be trained and what will be sufficient? – i.e. skilled to identify
a) the “risks of visual impairment” and
b) what rehabilitation is and if it is an option

8. Issue: not getting specialist assessment/assessed by specialist Legal: Deafblind people not receiving specialist assessment of needs from an expert
6.77 LAs must ensure that an expert is involved in the assessment of adults who are deafblind.
6.78 During an assessment the appearance of both sensory impairments…must trigger a specialist assessment. This assessment must be carried out by an assessor or team that has specific training and expertise relating to individuals who are deafblind.
6.36 …LAs must provide information about the assessment process in an accessible format [i.e. to vi as well as dual sensory]

9. Implications for workforce
Implies requirement for good screening
Requires LA to employ expert assessors
Requires LA to devise specialist assessment tool
Should encourage LA to keep deafblind register??
Requires LA to skill-up assessors
Adopt current SENSE guidelines (or will SENSE strengthen them)?
Just not enough Deafblind Studies Diploma holders – makes sense to strengthen Rehab. Worker skills to meet this need.

10. Current SENSE guidelines on skill level
Has demonstrable understanding of deafblindness and its implications …..
Is currently required to carry out assessments in a specialist role, either working with dual sensory impairment or with people who have a single sensory impairment [ie ROVI]
Has thorough knowledge of all legislation and guidance of relevance to deafblind people…. [i.e. social care law not just “section 7”]
Can communicate with the deafblind person themselves or with support from an interpreter

11. Issue: not being offered rehabilitation or early support Legal: failure to consider and offer any or timely assistance
2.38/6.85 LA must consider whether a person would benefit from… preventative services, facilities or resources.
6.85 …when doing so the LA may decide to pause the assessment to provide reablement…This will mean the determination of eligibility will be similarly paused until after the anticipated outcome of [rehabilitation]
2.19 In developing a local approach to prevention, the LA must take steps to identify and understand both the current and future demand for preventative support and the supply in terms of services, facilities and other resources available

12. Issue: rehabilitation provision is unsufficient/inappropriate Legal: failure to provide a service that meets need
2.8 LAs Must provide or arrange services, resources or facilities that maximise independence for those already with such needs, for example, interventions such as rehabilitation…
2.29 LAs should put in place arrangements to identify and target those individuals who may benefit from particular types of preventative support [particular types = vi rehab.]
22.23 LAs should consider securing specialist qualified rehabilitation and assessment provision...to ensure that the needs of people with sight impairment are correctly identified and their independence maximised………..

13. more on the nature of rehabilitation services
2.46 The regulations require that intermediate care and reablement provided up to six weeks, and minor aids and adaptations provided up to the value of £1,000 must always be provided free of charge.
2.48…In some cases, for instance a period of reablement for a person who has recently become sight-impaired, the support may be expected to last longer than six weeks…LAs should consider continuing to provide it free of charge beyond six weeks…in view of the clear preventative benefits…
22.23…As aspects of rehabilitation for people with sight-impairment are distinct from other forms of reablement, it should not be time prescribed. LAs should also refer to the ADASS position statement of December 2013.
6.78 [deafblindness] …Training and expertise should in particular include: communication, one-to-one human contact, social interaction and wellbeing, support with mobility, assistive technology and rehabilitation.

14. Implications for rehab. provision
It has to be shown to have been considered at assessment
The LA has to provide a service (by whatever arrangement)
VI rehab. is mentioned in law for the first time and the guidance references the adult sightloss pathway and ADASS’ statement on vi rehabilitation
Charging: slightly ambiguous, but strong indicators not to charge for it
No charging for equipment up to £1,000?
Duration: time limited but not time prescribed
Deafblind people: quite specific rehabilitative support identified in the act
Workforce planning: LAs need to be demonstrating they recognise future need and how they will meet Unmet need (6.24)
(16.52) Children and Families Act – habilitation service within core offer = combined services??

15. Eligibility
However the criteria are defined, it will be contentious and demand on budgets will be huge
Meeting eligibility much more likely with deafblind and people with LD
Significant influencing factor will be the technical way the assessment is undertaken: what questions are asked; how the questions are asked; how the answers are scored and equate to a budget. Type of questions are not conducive to getting sensory needs support
Focus on outcomes is welcome and makes the role of rehabilitation within the eligibility process (6.85) all the more crucial to local authorities and to individuals.
The inter-disciplinary implications of the above will be easier for in-house rather and outsourced rehab. Services to achieve?

16. Conclusions
The Care Act offers major opportunities to address early intervention needs of blind, partially sighted and deafblind people
The dust is nowhere near settling on the Act, so get in there!
Shrewd, knowledgeable campaigning will be required to achieve results