Community care services for people with a sensory impairment
An Action Plan
Annex 1 Summary of consultation responses
1. The Action Plan was generally welcomed by approximately 100 respondents, split evenly between individuals, local authorities, professional and voluntary bodies with advice being offered on additional statistical information, definitions on sensory impairment and on realistic timeframes for implementation as well as the financial resources that are thought necessary. Commitment was also given to working with the Executive to take the Action Plan through to implementation.
2. Some comments extended beyond the areas that the Plan seeks to address, notably further development of low vision services Specific concerns were also expressed about specialist needs, some of which are being addressed through other Scottish Executive initiatives e.g. the continued training of Rehabilitation workers.
3. Some unresolved issues will need to be addressed separately at a later date e.g. the continuing demand for specialist Section 7 guidance equivalent for Scotland. Such a measure would need detailed consideration to ensure that it is necessary, that it could not be achieved through existing mechanisms, and that it would achieve the desired goal of improved identification and better assessment of people who are deafblind. Ongoing monitoring of its introduction in England is at an early stage and it would be essential to be confident of its success in that context before considering an extension.
4. The majority of respondents support the need to consult on the best methods of collecting information to assist service planning and delivery, for all those with a sensory impairment, including consideration of the registration process. Appropriate methodology will be critical to ensure that not only numbers are captured but also differences in urban and rural populations to think through the subsequent implications for different models of service delivery. COSLA, as the organisation representing 31 of Scotland's local authorities, advocates caution in moving beyond voluntary registration because so that users are not labelled to access services. The extension of certification and registration to those with a hearing impairment was thought possible by some but again negative perceptions of the process would need to be overcome.
5. Several local authorities are already working on ensuring that the needs of those with a sensory impairment are incorporated into single shared assessment, although staff would need to be fully trained and aware of referral options. Others, predominantly from the voluntary sector, think it critical to combine single shared assessment with regular review of both the system itself and of the individuals who are assessed by it.
6. There was general support for the establishment of service standards for people with a sensory impairment with those in the voluntary sector advocating that the Scottish Best Practice Standards could form the basis of this work. Timescales for completion would need to be extended. Ownership thereafter by all parties would be essential as well as annual auditing of progress.
7. A review of existing information standards is also welcomed which should emphasise alternative communication mediums, including the availability and usefulness of information technology. COSLA stressed the importance of ensuring that necessary aids, equipment and personnel were in place for standards to be meaningful. Some voluntary sector providers indicated that the desired outcome should be an accessible information strategy aimed at ensuring all employers and public bodies establish arrangements that will enable them to obtain information in accessible formats.
8. There was also support for further research and the dissemination of good practice. COSLA , in particular, welcomed the opportunity to look at best practice and at the impact and costs of providing services to rural area as well as the differences or cost/benefits of direct provision versus commissioning services from the voluntary sector. Several respondents offered access to research they had already undertaken e.g. Glasgow and the West of Scotland Society for the Blind research on services. Others suggested that this recommendation could be adjusted to include extrapolation of existing research, nationally and internationally as well as considering ways in which existing good practice could be shared across Scotland.
9. The principle of having staff in every social work or social care facility who are able to meet the basic communication needs of a person with a sensory impairment is supported by the majority of local authorities. Some are already working locally to progress this. Concerns were raised about the ambitious timescale, recruitment and retention of staff, resources and whether care commission has or will be consulted. Voluntary sector providers stressed the necessity of having sufficient numbers of trainers available to meet training demands. They and local authority respondents asked that a next step should define what is meant by "basic communication needs" and "facility". A perception offered was that these terms could lead to only superficial training being carried out as a maximum rather than a minimum. It was also suggested that this proposal is extended to Health staff.
10. There was almost universal support for the development of a training strategy with many listing this as a top priority. Several respondents were keen that negotiations should take place immediately with social work and social care courses to minimise the time between course development and delivery.
Annex 2 Social Work Services Inspectorate (SWSI) Annual Report 2003
What follows are comments on sensory impairment services as they appear in the most recent SWSI Annual Report.
Aberdeen Council
Aberdeen and North East Deaf Society (ANEDS), Grampian Society for the Blind (GSB) and Deafblind Scotland provide most of the services for people with a sensory impairment. Specialist services have adopted, as far as possible, the Scottish Best Practice Standards.
Aberdeenshire Council
The authority should give priority to improving information on people with sensory impairment and improving the assessment process for sensory impairment services.
It is estimated that about 1031 people are hearing impaired or deaf, almost 900 are hard of hearing and 70 are profoundly deaf. There may be as many as 70 deafblind people, with 59 currently seeking a service.
Angus Council
The Council provides services for 39 people with hearing impairment and 16 people who are deafblind. There is a sensory impairment planning group. A local accommodation development is available for a small number of people who previously went to a residential school or who were in specialist care homes outside Angus.
Argyll & Bute Council
The Council should give priority to planning future provision - direct or commissioned - for people with sensory impairment based on local needs.
The Council's joint planning of services with Deafblind Scotland is important and two social workers support those people who are deaf or blind. In addition, a Rehabilitation Officer works with people with visual impairment. The Council has a deafblind register.
Clackmannanshire Council
A register of people who are blind and partially sighted is kept. People with hearing impairment or dual sensory impairment or who are deaf-blind have their needs recorded as primary or secondary care needs, and figures are available. 68 mostly older people with hearing impairment as the main problem and 29 mostly older people who are blind and deaf receive services.
Dumfries & Galloway Council
In 2002-2003, 320 people with a hearing impairment received a service and of those seven were deaf-blind. Currently, there are 164 hearing impaired open cases and nine people who are deafblind who are open cases. There is a need to develop stronger links for older people with sensory impairment to the sensory impairment teams.
Dundee City Council
68 deafblind people and 44 hearing impaired people are receiving a service. These do not include older people who have not identified themselves within these specific categories. Specialist services are provided through Dundee Society for the Visually Impaired and the Society for the Deaf. The Council monitors their activity service level agreements. An action plan is being put in place for sensory loss services.
East Ayrshire Council
The Council acknowledges the need for a more focused approach to developing services for sensory impairment. However, work has been going on for some time and the Council has consulted service users, who highlighted what they want out of services - improved communication, a single contact in social work and shorter waiting times (especially response time for rehabilitation staff).
No deafblind people are known to services. In the past year, 231 people who are deaf and hearing impaired received or are receiving a service and there were 716 instances of using sign-language interpreters.
East Dunbartonshire Council
The Council estimates that 1,450 hearing impaired people and 100 deafblind people receive a service. It is commissioning Deafblind Scotland to do specific work with deafblind people. 22 deafblind people are receiving a service at the moment. A resource centre is being set up at Lenzie for people who are deafblind.
East Lothian Council
The authority should give priority to making sure that the local Sensory Impairment Group prepares a plan to develop and put in place services to meet local needs.
In 2001-2002, 300 people had with visual impairment - 86 were under the age of 60 and 34 were partially sighted. Services for people with sensory impairment are planned through the Sensory Impairment Sub-Group which is a Lothian-wide group. The group hopes to identify needs which have not been met.
East Renfrewshire
The information currently available on individuals with sensory impairments is unreliable and the Council is reviewing the way it is collected. Services for people with sensory impairments are being developed as needs are recognised, by recording of unmet needs on an individual basis and through the Community Care Advisory Group and the joint planning process. Services are currently being reviewed with statutory agencies, the voluntary sector, users and carers, as a step to developing a joint strategy for developing services. The ScoD standards are followed and East Renfrewshire believes it is meeting all the recommendations set out in the Royal National Institute of the Blind UK document 'Progress in Sight'.
City of Edinburgh Council
There are 180 deaf and blind people and people with hearing difficulties receiving a service. The Council plan services using Royal National Institute of the Blind figures as they do not have a database for planning and developing services for people with sensory impairment.
Eilean Siar Council
There is a support worker for people with sensory impairment who is a service provider and a link to other specialist services. This worker provides assessment, equipment, referrals on and advocacy. Western Isles know of no deafblind people but admit that the process of sharing such information with Health is not well joined up. Western Isles Council should consider developing this further with Health.
Falkirk Council
Planning of services is on a multi-agency basis. Links with people with impairments are through the Sensory Impairment Resource Centre, a user group, deafblind communicators working within the Council, specialist agencies such as the Royal National Institute of the Blind and the Royal National Institute for the Deaf, and eye clinics where there is joint working. Services are co-ordinated by a senior social worker. The multi-agency planning group has adapted service standards for local use. A new Forth Valley multi-agency centre is being planned to provide one point of contact for sensory impairment services and social facilities.
Fife Council
There are estimated to be 140 people in Fife who are deaf and blind, of which 60 receive a service. The number of people wanting an interpreting service is increasing fast and it is impossible to keep up with the demand (1082 assignments in 2002). A Fife Sensory Impairment Steering Group provides a forum for service providers and representatives from user groups to consult together.
A Sensory Impairment Centre provides a base for all the organisations dealing with people with sensory impairment. The centre provides an assessment and rehab service for people with a visual impairment through Fife Society of the Blind. The RNIB provides an assessment service there for people with sensory impairment and learning disability. Social Work Service has contracts with both these organisations for providing the services.
Social Work directly manages the Deaf Communications Service, which provides an interpreting service, runs groups for hard-of-hearing service users, and teaches British Sign Language to interested professionals, volunteers and hearing relatives of deaf service users. It is difficult to recruit interpreters for the service, which means that the Council cannot always meet the increasing demands being made on the service.
Healthy Living Project in Sensory Impairment aims to raise awareness of sensory impairment issues among health service staff. This is in response to recent local research which showed that many deaf service users do not seek help for health issues because of the communication issues they meet.
Glasgow City Council
Figures in Glasgow City Joint Community Plan 2001-2004 suggest that there are around 11,000 severe and 45,000 moderate hearing impaired people. No figures for other client groups were available at the time of the annual report visit.
The visual impairment awareness pack, developed in response to recommendation six of 'Sensing Progress' had raised awareness, and will be followed up with level 1 sign language training.
Highland Council
The authority should also give priority to developing with key stakeholders a strategy for sensory impairment services across the whole area.
A planning group has been in existence since 1995, focusing on the needs of those with hearing loss. A multi agency, multi-disciplinary working group set up in 2002 is developing a single strategy for sensory impairment and is scheduled for completion in December 2003. Services are currently provided by a team for blind services and the Council buys these services from the Society for the Blind and its centre in Inverness. They cover over 200 adults and a similar number of hearing impaired children.
Inverclyde Council
The Council is not aware of any deafblind people. The number of people with hearing impairment reflects current national rates. Services for people with sensory impairment are planned through the community care planning process. The Disability Resource Centre is moving to a new location and aims to secure a room to display new technology for helping people and to provide stronger links to the local ophthalmology clinic.
Moray Council
The number of people with sensory impairment receiving a service reflects the 1,000 people registered with the two specialist societies the Council has service level agreements with. Agencies have very little contact with each other. The Council will develop a strategic plan for people with disabilities, including sensory impairment. The Disability Forum is carrying out a survey with users in the Moray Resource Centre on using services.
North Ayrshire Council
In North Ayrshire, 163 people who are registered as blind also have a hearing impairment and 29 people who are registered as partially sighted also have a hearing impairment. 228 service users with hearing impairments used social work services last year, as well as 10 people who are deafblind.
Services are planned through the All-Ayrshire Joint Planning Group. A Sensory Impairment Team has been formed from two separate teams to provide better services. A review is planned of sensory impairment services, which would build on the national service standards documents.
North Lanarkshire Council
The Council works with Deafblind Scotland and Lanarkshire NHS to identify the number of people with sensory impairment and their needs. They have already identified 45 people who are deafblind (35 of them have been newly assessed and six have been re-assessed as needing services they do not already have).
Orkney Islands Council
The Council provides sensory impairment services for two deafblind people and 42 with hearing impairment (12 of them are deaf).
Perth & Kinross Council
The authority should give priority to setting up systems for identifying the number of people with sensory impairment and their community care needs, as a basis for developing local services.
No information is available on how many people locally have a hearing impairment or deafblindness. Tayside Association for the Deaf has a database of people with a hearing impairment. Perth and Kinross Society for the Blind keeps the local register of blind and partially sighted people.
The Sensory Subgroup has a strategic planning role, involving the voluntary sector, service users and carers, and there are links to education and children's services. Progress in Sight is used as a reference for the developing awareness training programme.
Renfrewshire Council
Social services know of 154 people who are partially sighted and deaf, partially sighted and hearing-impaired, blind and hearing-impaired, or deafblind. Visual and hearing-impaired units at the Mile End Centre bring together social work and health staff, including occupational therapists, led by two senior social workers. Their range of services includes assessment, equipment and adaptations, demonstrations, interpreting and translating. At the moment, 11 people receive services from both units.
Scottish Borders Council
There is no formal process for collecting information on people with hearing impairments. However, there is a register for people who are blind or partially sighted. At the moment, 33 people identify themselves as deaf (people who use sign language), 680 as partially sighted and 120 as blind. Services for people with sensory impairment are planned with the help of user groups which feed into the consultation and planning process, such as the Physical Disabilities Working Group, part of the Community Care planning process.
There is one visual impairment development officer, one social worker for people who are deaf or hard of hearing, and one visual impairment rehabilitation officer.
Shetland Islands Council
The number of service users who are hearing-impaired and deafblind are thought to be 'the tip of the iceberg'. The Council is developing a database as part of the Disability Strategy, and this should give more accurate information to help in planning services.
South Ayrshire Council
There are 875 registered visually impaired people, and 300 of them have some form of hearing impairment. Four sign language users are visually impaired. The Council plans services in consultation with service users and voluntary organisations, as well as the sensory impairment group.
South Lanarkshire Council
An independent study commissioned from Deafblind Scotland identified 61 deafblind people, who all receive services. There were seven deaf-blind service users who got Supporting People funds to the value of 118,690. Locally, there are about 1,700 people aged 16 and over with a severe hearing impairment and in 2002 the Council provided services for 568 people with moderate or severe hearing impairments.
A multi-agency group and three task groups (each for a specific group of service users) are helping to put the recommendations of 'Sensing Progress' into practice. The individual groups have identified service priorities and developed work plans for services for people with sensory impairments.
Stirling Council
The authority should give priority to reviewing services for people with sensory impairment.
The Council uses estimates for sensory impairment based on the population and national statistics about hearing-impaired and deaf-blind people. Services are planned on a Forth Valley-wide basis, with input from a disability steering group. There is a local Sensing Progress Implementation Group and a Forth Valley resource centre for sensory impairment is planned for next year, jointly with the Royal National Institute for the Blind. This includes contributed funding from Stirling Council.
West Dunbartonshire Council
The Council is working with Deafblind Scotland and Greater Glasgow Health Board to conduct a survey on the number of deafblind people and people with significant hearing impairment. A development worker for sensory impairment has been appointed to work with the different groups.
West Lothian Council
There are no figures available for the number of people with a sensory impairment or for the number of people receiving a generic service, such as home care. So services are planned on the basis of national figures.
West Lothian is developing training to make staff more aware of people's sensory needs. The Council also has a link with the Royal Blind School to help young people move into adult services.
Annex 3 Disability Discrimination Act 1995
(Disability Rights Commission Summary (Extract))
For a deaf person who uses British Sign Language as his or her main form of communication, having a qualified BSL interpreter is the most effective method of communication. This is because for people whose first language is BSL (rather than spoken or written English) exchange of written notes or lipreading can be an uncertain means of communication.
British Sign Language Interpretation may not be easily available and should be arranged in advance wherever possible. If an interpreter is not available, the service provider should consider an alternative method of communication, in consultation with the deaf person.
The Act leaves open what particular auxiliary aids or services might be provided in specific circumstances. Disabled people may be able to help the service provider to identify difficulties in accessing the service and what kind of auxiliary aid or service will overcome them. It is good practice to include disabled customers in the process of considering what reasonable adjustments should be made. However the duty remains on the service provider to determine what steps it needs to take.
In many cases, a service provider will need to consider providing auxiliary aids or services to improve communication with people with a sensory impairment (such as those affecting hearing or sight) or a speech impairment or learning disabilities. The type of auxiliary aid or service will vary according to the importance, length, complexity or frequency of the communication involved. In some cases, more than one type of auxiliary aid or service might be appropriate, as different people have different communication requirements. Account should also be taken of people with multiple communication disabilities, such as deaf-blindness or combined speech and hearing disabilities.
Provision for people with a hearing disability
For people with hearing disabilities, the range of auxiliary aids or services which it might be reasonable to provide to ensure that services are accessible might include one or more of the following:
written information (such as a leaflet or guide);
a facility for taking and exchanging written notes;
a verbatim speech-to-text transcription service;
induction loop systems;
subtitles;
videos with BSL interpretation;
information displayed on a computer screen;
accessible websites;
textphones, telephone amplifiers and inductive couplers;
teletext displays;
audio-visual telephones;
audio-visual fire alarms;
qualified BSL interpreters or lipspeakers.
Where sign language interpretation is used as an auxiliary service the interpreter should be capable of communicating accurately and efficiently with both the disabled person and the other parties involved. Other interpretation services such as lipspeakers and Makaton communicators should similarly be capable of communicating accurately and effectively.
Service providers should bear in mind that hearing impairments take many forms and are of varying degrees. What might be a reasonable auxiliary aid or service for a person with tinnitus or reduced hearing might not be a reasonable adjustment for someone who is profoundly deaf.
Provision for people with a visual impairment
For people with visual impairments, the range of auxiliary aids or services which it might be reasonable to provide to ensure that services are accessible might include one or more of the following:
readers;
documents in large or clear print, Moon or Braille;
information on computer disk or e-mail;
information on audiotape;
telephone services to supplement other information;
spoken announcements or verbal communication;
accessible websites;
assistance with guiding;
audio description services;
large print or tactile maps/plans and 3-dimensional models.
Deafblind people are not necessarily assisted in accessing services by the simple provision of communication aids designed for people with hearing disabilities or visual impairments. Such aids could assist deafblind people if appropriately used e.g. information leaflets produced in Braille or Moon or acoustics, induction loop systems etc. However, what is appropriate will depend on the nature and extent of the individual's sensory impairment and the method she uses to access information. Adjustments which may be of use to a deafblind person might include engaging a deafblind manual interpreter for important meetings or having a member of staff trained in specific ways to help a deafblind person. Where service providers give their staff disability awareness training it could include safe guiding and tracing capital letters and numbers on the palm of the hand.
Annex 4 Responses were received from the following:
Aberdeen & North East Deaf Society
Aberdeen City Council
Aberdeenshire Council
Angus Council
Argyll & Bute Council
Caithness Deaf Care
Clackmannanshire Council
Convenor, Stirling VIP's
COSLA
Deafblind Scotland - Chief Executive
Deafblind Scotland - Director
Deafblind Scotland - Training
Desmond Smith
Dr John Womersley
Dumfries & Galloway Council
Dundee Blind & Partially Sighted Society
Dundee City Council
East Ayrshire Council
East Lothian Council
East Renfrewshire Council
Edinburgh & East of Scotland Deaf Society
Edinburgh City Council
Falkirk Council
Fife Council
Fife Sensory Impairment Steering Group
Fife Society for the Blind
Forum of Providers of Social Work Services to Deaf People (Scotland)
Glasgow and West of Scotland Society for the Blind
Glasgow and West of Scotland Society for the Blind Users Group
Glasgow City Council
Grampian Society for the Blind
Hayfield Support Services
Highland Council
Highland Society for Blind People
Lynne Hawcroft Associates
M Hickinson
Maclar Disease Society
Miss E A Burns
Miss Evelyn Brown
Moray Council
Moray Deaf Club
Mr & Mrs J Gallagher
Mr Clark Steven
Mr George C Simpson
Mr Gerard Dillon
Mr Gordon James Donnelly
Mr John Moore
Mr Matty Blacklaw
Mr Michael Stoddart
Mr RJN Nolan
Mr W Rae
Mr William Houldsworth
Mrs Elizabeth Black
Mrs Peggy Patterson
Ms Angela Muir
Ms Ann Dobbie
Ms B Hickinson
Ms Beth Morrison
Ms Braeside House
Ms Christine Fry
Ms Dorrie Moore
Ms E Deerieah
Ms Eelidh M Scobbie
Ms Elizabeth Blackburn
Ms Jane Johnston
Ms Linda Anderson
Ms Louisa Wardlaw
Ms Mary Downing
Ms Mary Duncan
Ms Mary Wilson
Ms Pauline B Topham
Ms Wilma McCabe
Ms Zena Walker
National Association of Inspection & Registration Officers
NHS Greater Glasgow
North Ayrshire Council
Orkney Islands Council
Perth & Kinross Council
Renfrewshire Council
RNIB Scotland
RNID Scotland
Scottish Association of Sign Language Interpreters
Scottish Borders Council
Scottish Council on Deafness
Scottish Disability Equality Forum
Society for Mental Health & Deafness
South Ayrshire Council
South Lanarkshire Council
Stirling VIP's - Vice Convenor,
Tayside Association for the Deaf
The Council for Advancement of Communication with Deaf People,
The Scottish National Federation for the Welfare of the Blind
Visual Impairment Ayrshire
West Dunbartonshire Council
West Lothian Council
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