Leading sight loss charity, the Royal National Institute of Blind People (RNIB), is calling for action from the government and the National Institute for Health and Care Excellence (NICE) to ensure that blind and partially-sighted people can access visual rehabilitation. The charity’s Life on Pause report reflects on the findings of RNIB’s recent research and highlights that people with sight loss are not receiving the timely and potentially life-changing, specialist visual rehabilitation that local authorities have a legal duty to provide. RNIB emphasises that proper visual rehabilitation equips blind and partially-sighted people with the practical and emotional skills that they need to live a safe, fulfilling and independent life. Without access to support, people with sight loss risk accidents, unemployment and isolation, with resulting effects on their physical, emotional and mental health. RNIB estimates that more than 1.8million people in England are living with sight loss that is severe enough to have a significant impact on their daily lives. Around 84,000 registered blind and partially-sighted people are of working age. Many are living with their lives on pause, as they wait for vital assistance. What is vision rehabilitation? Vision rehabilitation helps blind or partially-sighted people to adapt physically and emotionally to living independently and safely, getting out and about, and participating in work and other activities. Effective vision rehabilitation involves specialist assessment of the individual’s needs followed by provision of specialist equipment and personalised support, including mobility or white cane training, technology training, support with working, cooking and other daily tasks, as well as emotional support. Effective and timely vision rehabilitation enables blind or partially-sighted people to continue living in their home, reduces accidents and healthcare visits to A&E, GP and mental health services, and reduces reliance on community transport services and professional (paid) and/or family care. RNIB points out that with the necessary support and tools, such as assistive technology, many people with sight loss can successfully work in almost all employment sectors, enhancing their finances, sense of purpose and quality of life. Despite these benefits, RNIB describes vision rehabilitation as a ‘hidden service, flying under the radar at the crossover between health and social care’. The charity notes that vision rehabilitation is the only specialist‑assessed service that is not monitored or inspected by care regulators. RNIB’s report reminds the government that English local authorities have a duty under the Care Act 2014 to prevent, reduce and delay the need for care and support. Anyone with needs related to sight loss can ask for vision rehabilitation and their local authority must carry out a needs assessment where there is ‘an appearance of need’ for care and support. This is not conditional on the severity of the person’s sight loss or whether they have a Certificate of Vision Impairment (CVI). The individual can be referred by their health and care providers, or they can self-refer to their local rehabilitation team. However, despite their legal entitlement, RNIB believes that thousands of people with sight loss miss out on this vital support every year. How accessible is vision rehabilitation in England? RNIB’s recent research found that, despite being a lifeline for many blind and partially sighted people, access to post‑diagnosis vision rehabilitation and support is a ‘postcode lottery’. In 2023, their survey of 400 people who are living with sight loss revealed that 44% of blind and partially-sighted people had never received vision rehabilitation support in their lifetime. Late last year, RNIB made a Freedom of Information (FOI) request to 153 local authorities in England to gain an accurate understanding of vision rehabilitation service provision. Their findings are based on the information provided by the 139 authorities (91%) which responded to their FOI request. Unacceptable waiting times for support RNIB found that people with needs from sight loss experienced unacceptable waiting times for support. On referral for vision rehabilitation, people should first receive contact from the local authority to advise them about available support. This contact should take place within two days of the referral. They should then have an assessment of needs, following which they should receive their support. RNIB found that: 32% of local authorities took more than 10 working days to respond to a referral; 85% did not complete all of their vision rehabilitation assessments within RNIB’s recommended 28 days; 20% (one fifth) of local authorities had people waiting over a year for a vision rehabilitation assessment. Shortage of qualified vision rehabilitation specialists RNIB found that workforce challenges are preventing people from accessing vision rehabilitation. Nearly a quarter (24%) of local authorities had vacancies for vision rehabilitation specialists, adding strain to the existing overstretched workforce. More than 55 authorities said they were using (unqualified) vision rehabilitation assistants and/or apprentices to carry out needs assessments and deliver vision rehabilitation services, with the risk that people’s needs are not fully recognised leading to inadequate support. RNIB found that reduction in team sizes and available specialists and resources meant that local authorities were breaching their duty to provide rehabilitation by limiting the scope of their services, and restricting access to only provide for those with the most severe needs or circumstances. RNIB emphasise that there are no formal eligibility requirements or thresholds for people with sight-loss needs to receive vision rehabilitation, which is not conditional on the individual having a CVI or sight-loss registration. Limited range of rehabilitation RNIB’s research found that local authorities most commonly provided rehabilitation for the practical aspects of sight loss, such as long cane training, use of low vision aids, support with daily living skills (cooking, dressing, cleaning), orientation and mobility training. However, they found that essential support with technology and provision of ‘high tech’ equipment such as tablets, teaching of braille, emotional and psychological support, and additional advice and support for the individual’s family and carers were not routinely provided, even though these can be vital in enabling blind and partially-sighted people to live fully independent lives. Instead, local authorities signposted people to other organisations or charities for additional help or provision. Lack of NICE guidance or regulation of vision rehabilitation services NICE guidelines on intermediate care and reablement exclude vision rehabilitation services from the scope of the guideline. RNIB has repeatedly called for NICE guidance to ensure consistent and effective vision rehabilitation services, but report that NICE has rejected their requests for vision rehabilitation to be included in their guidelines. RNIB’s research found that 75% of local authorities support RNIB’s call for NICE‑led quality standards, with no local authorities saying that they do not support the recommendation for NICE vision rehabilitation guidelines. In addition, vision rehabilitation specialists remain an unregulated profession. RNIB calls for formal recognition for qualified vision rehabilitation specialists and regulation of vision rehabilitation services to ensure that vision rehabilitation specialists are properly trained and accountable for their work. Helping blind and partially-sighted people access rehabilitation and compensation RNIB’s stark and concerning findings highlight the barriers to vital rehabilitation that are encountered by blind and partially-sighted people who rely on support to live independently and move safely through their day. Where an individual’s sight loss was caused by the negligence of an employer, driver or healthcare provider, funding and provision for specialist needs assessment, equipment, rehabilitation and support can be accessed via a personal injury or medical negligence claim. Each of our blind and partially-sighted clients’ needs are fully and individually assessed to ensure that provision for the specialist equipment, home adaptations, private medical eye care, therapies, vocational or SEN support that they need is included in their compensation claim. In claims where Rehabilitation Code funding or interim payments can be secured, we can often work with case managers and proven teams of rehabilitation specialists to get our clients’ rehabilitation underway before the final settlement of the claim. Read more about our approach to personal injury rehabilitation. Read more about sight loss medical negligence claims. If you have been seriously injured in a road collision, or accident at work, school or public facility, or as a result of medical negligence, and you would like to find out more about funded rehabilitation or making a claim, you can talk to one of our experienced solicitors, free and confidentially, by contacting us.
