CQC Quality Statements

Theme 3 – How the local authority ensures safety in the system: Safe systems, pathways and transitions

We statement

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between services.

What people expect

When I move between services, settings or areas, there is a plan for what happens next and who will do what, and all the practical arrangements are in place.

I feel safe and supported to understand and manage any risks.

1. Introduction

Local authorities must keep a register of people who are severely sight impaired and sight impaired.

Registration is voluntary, however individuals should be encouraged to consent to being registered as it may assist them in accessing other relevant support services and benefits. People who agree to be registered may be entitled to some benefits, for example, an increase in personal tax allowance, a reduction in the cost of a TV licence, a free bus pass and parking concessions under the Blue Badge Scheme. It is important that strong links exist between local authorities, health services and voluntary organisations to identify those who may benefit from registration.

The data which registration provides the local authority are also of benefit in service planning for health and care and support. However, access to care and support is not dependent upon registration, and those with eligible needs for care and support should continue to receive it regardless of whether they wish to be registered.

Local authorities should help health and social care organisations to work together to meet the needs of people who have sight loss, for example, ensuring that care and support services know what help somebody needs in their home when they leave hospital. Timely assessment and person centred care and support planning that is integrated with health care offers the potential to make improvements in experience and outcomes for people who are sight impaired, as well as improving system efficiency.

2. Registration

If the person consents to registration they will be included on the local authority’s register and be provided with a registration card. The register can also be used by the local authority to ensure that accessible information about services is provided to the person, for example to ask if support could be given to assist them to participate in electoral events.

3. The Certificate of Vision Impairment

The Certificate of Vision Impairment (CVI) formally certifies someone as being sight impaired or as severely sight impaired. Where the person has given their consent, a copy of the CVI should be sent to the local authority by the hospital staff. However, people in receipt of a CVI should not be added to the local authority register until they have given their specific consent for registration.

Local authorities may take the date of certification given on the CVI as the effective date of registration. If the adult has not given their consent for their name to be added to the register of sight impaired adults, however, they should still be offered a needs assessment.

The CVI is an important source of information for local authorities in relation to their registration duties. The local authority should satisfy themselves that the CVI is completed correctly and it contains valid signatures as required (currently the consultant ophthalmologist and the patient). Both electronic versions and paper copies of CVIs can be accepted for registration.

3.1 Certification

The CVI is issued by a consultant ophthalmologist to the patient certifying as sight impaired or severely sight impaired. The Certificate of Vision Impairment: Explanatory Notes for Consultant Ophthalmologists and Hospital Eye Clinic Staff (gov.uk) explains who should be certified as severely sight impaired and sight impaired.

Certification is not the final stage, but often it is the point when people begin to accept the severity of their sight loss and feel ready to access to practical and emotional support.

It is expected that NHS services will keep the completed certificate, signed by the consultant and the patient, for their records. Where the patient has given their consent, a copy of the certificate should be sent to the relevant local authority and the patient’s GP within five working days of its completion. The ‘Certificate of Vision Impairment Explanatory Notes for Consultant Ophthalmologists and Hospital Eye Clinic Staff’ provides information on this.

Local authorities should note that there will also be people who have a reduced / low vision but do not meet the criteria for certification, their needs should still be considered in service planning.

3.2 Transferring and retaining the CVI

The CVIs should be kept until the person moves to another area or has passed away. In the event of a person’s death, the local authority should keep the CVI for at least six years as it may be necessary for tax purposes to establish if a deceased person was registered with a local authority.

3.3 Making contact

Within two weeks of receiving the CVI, the local authority should make contact with the person issued with the CVI to arrange their inclusion on the local authority’s register (with the person’s informed consent) and offer them a registration card. Where there is an appearance of need for care and support, local authorities must arrange an assessment of their needs in a timely manner.

To maximise the ability of people who have sight impairment to be involved in their own care and decision making, they should have early access to information and advice in an accessible format so that they can adapt to their situation as quickly as possible and obtain any aids and support that will help them to manage their lives better.

4. Continuity of Care

A person may decide to move home and live in another local authority area (see Continuity of Care chapter). The first local authority should ensure that the person’s care and support needs will continue to be met during their move. The process requires the original authority to provide the authority the person is moving to with relevant information to support the move such as a copy of the person’s care and support plan, their latest assessment, and any other documentation the second authority requests. This should include a copy of their CVI. The second authority should add the person to their register (if they give their consent for this), and the former authority should remove that person’s name to avoid duplication.

(For more information see Ordinary Residence chapter).

5. Care Planning

Royal National Institute for Blind People (RNIB) have developed resources to help social care professionals care for people with sight loss.

Following completion of a needs assessment, the local authority must prepare a care and support plan for everyone with eligible needs or other needs which it is going to meet. Where someone has sight loss, this should be recorded in the care and support plan (see Care and Support Planning chapter).

Local authorities should consider securing specialist qualified rehabilitation and assessment provision (whether in-house, or contracted through a third party), to ensure that the needs of people with sight loss are correctly identified and their independence maximised. Certain aspects of independence training with severely sight impaired and sight impaired people require careful risk management and should only be undertaken by professionals with relevant experience and training. This type of rehabilitation should be provided to the person for a period appropriate to meet their needs, and this will help the person to gain new skills, for example, training to use a white cane. See Care Act 2014 and Sight Loss (ADASS).

Rehabilitation for sight impaired people is a specific form of reablement and is not limited to the usual six week period for rehabilitation as this could take longer. There are some characteristics which define rehabilitation as being distinct from other forms of reablement. It is therefore not appropriate to take a one-size-fits-all approach, and the local authority needs to ensure that individual needs are met appropriately.

6. Other Registers

Local authorities may also establish and maintain a register of people living in their area who have a disability (a physical or mental impairment which has a substantial and long term adverse effect on their ability to carry out normal day to day activities) or who need care and support or are likely to do so in the future. (This is a power to maintain a register, as opposed to a duty to do so as per the sight register.)

Inclusion on registers is voluntary and with the individual’s informed consent. However local authorities should encourage individual’s consent to inclusion on the register as such registers may support the establishment of an accurate and useful local record of people whose needs may change over time, for example:

  • someone with a progressive long-term condition whose needs may increase over time;
  • when the person on whom they are mainly dependent for their care has stopped providing care;
  • those who are ordinarily resident but may be receiving temporary care and support out of area, or in-patient treatment in health services, but who are likely to require care and support on their discharge or return.

Local authorities may wish to link the information collected to the Joint Strategic Needs Assessments (JSNAs) as well as the Joint Local Health and Wellbeing Strategies (see Joint Strategic Needs Assessments and Joint Local Health and Wellbeing Strategies chapter). They may also, as part of local JSNA and Health and Wellbeing Strategy development, want to look at this information alongside complementary information from other partners, for example, information drawn appropriately from registers of people with learning disabilities or particular health conditions which are held by GPs, in order to produce a comprehensive and accurate shared local picture.

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