Reflections on sight loss - RNIB

Viewpoint
Simon Labbett:
“Referral routes are the acid test”
I think some people have this image of health
and social care workforces as like two
dysfunctional parents arguing over the best
way to look after their child and that
everything would be fine if we both just sat
down, listened to each other and talked.
Actually health and social care do talk to each
other. Ask any of us who work with Low Vision
Service Committees or on the UK Vision
Strategy.
For frontline workers the acid test of all the
fine rhetoric of joint-working is: do the
referral routes actually work? In this respect
the focus tends to be on the crucial liaison
between hospital and social work teams at
Point-of-Diagnosis (POD). This is where the
bulk of joint-commissioned sight services lies
and is evidently where RNIB sees the
strategic need. It would be foolish to argue
with this priority. There are also encouraging,
though rare, models of joint-commissioning
and co-operation in the field of low vision
provision. However, we neglect other
health/social care “border points” at our
peril.
Two spring to mind immediately: One is the
referral at hospital discharge i.e. from hospital
social workers, occupational therapists and
physiotherapists. This is problematic, in part,
because referrals often go to the older
people’s team, and not the sensory needs or
disability team. Second is the woeful liaison
between hospital stroke care and visual
impairment teams – in hospital and social
care. In both these situations the loser is often
a person without diagnosed sight loss or
someone with longstanding sight loss, and in
these situations the
solution lies not
through a new commissioned service: it lies in
old-fashioned cross-team talking and
awareness training – the sort of stuff most
workers never quite have enough time for.
And the reward for those that do make the
time is more referrals!
There are still plenty of indications that eye
clinic staff do not understand what social care
is about, and indeed you could argue that the
provision of eye clinic liaison officers (ECLOs)
or PODs run the risk of making consultants
and nurses less empathetic. But it works both
ways – I have to admit that, until I spent a day
shadowing an ophthalmologist’s surgery, I had
a rather false idea of what an outpatients
clinic was actually like. Suffice it to say, not
every patient they see actually needs social
care (or RNIB)!
Frankly, even if health and social care was
fully joint-funded there would still be
communication problems; wherever two
professions are gathered together their
training will lead them see “problems”
differently. Which leaves us wondering where
the visually impaired person comes in? I think
they are the ones to knock heads together. I
believe one good outcome of rehabilitation
work is to empower people to get involved in
decision-making that affects them. To stretch
the parenting analogy a bit, it’s a bit like when
your teenage children start pointing out your
own poor parenting.
Simon Labbett is a rehabilitation worker in
Bradford
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