Reflections on sight loss - RNIB

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Viewpoint Viewpoint: working together How can the interface between eye clinics and secondary care be improved? Three professionals from different disciplines in the health and social care sectors share their views Janet Marsden: “Timely support is essential” How should the interface work for people who are attending outpatient clinics with low vision? My ‘model of care’ comes from the Low Vision Pathway (DH2004) and starts at the very beginning of the low vision journey where a patient is referred to a low vision service. The pathway says that the referral can be from anyone, including the patient. The ‘new’ process for notification was introduced in 2003 and includes a low vision leaflet (LVL) for self referral, a Referral of Vision Impaired Patient (RVI) for hospital eye clinics to use before a Certificate of Visual Impairment (CVI) is required and the CVI itself. The Royal College of Ophthalmologists published a statement in 2007 highlighting a significant fall in the number of patients referred using the CVI form. The Chief Medical Officer reflected this, also in 2007, but went further stating that neither health nor social services staff were using the forms correctly. 20 My investigations have been informal but I’ve found some interesting things. I spoke to a number of nurses working in various eye clinics, and none of them were aware of the LVL or the RVI form, which can be filled in by any eye health professional who feels, with the patient, that some support is necessary. This is an opportunity missed for linking with social services and highlighting those patients who have problems now and who may need more support later. “Information should always be a two-way process and the difficulties of running a busy outpatient department are not to be underestimated” Not only don’t nurses know what the process is, they seem to have little to do with it.
Viewpoint Nurses reported that there were social workers within the outpatients department but that the nurses didn’t have much to do with them as doctors did all the registrations! These might be isolated cases, but I fear that they’re not! There are many resources in outpatients. We may have eye clinic support officers, representatives from charities, counsellors, ophthalmic nurses and ophthalmologists but the system still seems very fragmented, with things happening, but not in a joined up way, and with the main signposters of the department – the nurses – unaware of the systems which should be in place. Information should always be a two-way process though and the difficulties of running a busy outpatient department are not to be underestimated. It’s sometimes surprising that the nurses have time to breathe, never mind know what everyone else around them is supposed to be doing! All this makes life very difficult for patients though. Timely support for people with sight loss is essential and if we can’t make the first step smooth, the rest of the journey may be very rocky indeed. Janet Marsden is Professor of Ophthalmology and Emergency Care at Manchester Metropolitan University. She specialises in Advanced Nursing Practice, Ophthalmology and Emergency Care. Diane Roworth: “A long and lonely walk” What a long and lonely walk it is, down the corridor and out into the real world. As you leave the eye clinic, your mind is in turmoil. You went, expecting an explanation and treatment that would restore your vision to normal. But not so. All the words that you understood a few moments ago are suddenly forgotten, apart from the ones – I am sorry, but there’s nothing more I can do. On hearing those words, some people get immediately upset, others put on a brave smile and pretend its okay. Some people will ask questions about why – will I lose more sight, what does the future hold? Others will be quiet, perhaps their carer asking all the questions. The one thing they all have in common is that, after hearing those awful words, they now have to go home and live their lives, knowing they have a visual impairment for which there is no ‘cure’. They will not regain lost sight, and may perhaps lose more as time goes on. How are they going to manage, when the world as they know it seems to be crumbling around them? ➜ 21
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