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Business Case Guidance
Developing a sight loss adviser service (ECLO)
Purpose
This guidance is to assist professionals who are in the process of
building evidence and developing a case for a sight loss adviser,
also known as an Eye Clinic Liaison Officer (ECLO). This
document provides an overview of the role and links to key
statistics and information which can be used to build a case for the
support service.
Action for Blind People’s national Business Development team
leads in the development of sight loss adviser services across
England. The team are able to offer free expert advice and support
to help build a business case for this vital service.
Details on who to contact to find out more about this support can
be found at the end of this document.
Background to sight loss adviser
Sight loss advisers have been established for 15 years. They
provide patients, their families and carers with practical and
emotional support to help understand their diagnosis and adapt to
living with sight loss. The service is a proven approach to
integrating health and social care. Sight loss advisers work closely
with staff in eye departments and local authorities to offer patients
the support that they need.
Professional service
Sight loss advisers are trained in the role and offer a high quality
professional and integrated service. Professional training is
provided by RNIB’s Eye Clinic Support Studies course accredited
by City University London.
To ensure the quality and high standard of this role, the service
must adhere to the following quality framework which identifies the
RNIB – supporting people with sight loss
RNIB charity numbers 226227, SC039316 and 1109
elements that make an effective sight loss adviser service. It can
be downloaded here:
ECLO / sight loss adviser services: RNIB Practice guidance and
quality framework (Word, 33 KB)
Economic case for investing in a sight loss
adviser
Social return of investment
A recent social return of investment has found that a sight loss
adviser can make a unique saving, over one year, to health and
social care budgets of £10.57 for every £1 invested [1].
Reducing GP appointments
Sight loss advisers provide ongoing information, advice and
guidance. They act as a point of contact which can reduce the
need for patients to have follow-up GP appointments.
Reducing the number of falls
Almost half (47 per cent) of all falls in the population of people with
visual impairment were directly attributable to the persons sight
loss [2]. It is estimated that visual impairment related falls amount
to 10 per cent of the cost of all falls in the UK [3].
RNIB’s Sight Loss Data Tool breaks down the number of falls that
can be attributed to sight loss to a local authority level. It can be
accessed here: Sight Loss Data Tool
Sight loss advisers can play an integrated role in reducing the
number of falls by routinely administering fall assessment
questionnaires and providing advice to patients about where to
seek help and support. They can directly refer patients to local fall
prevention programmes, and follow up with falls teams to measure
impact.
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Key benefits to eye departments
Saving clinicians’ time
Sight loss advisers can improve clinical staff efficiency by reducing
time spent with distressed patients. It is estimated that a sight loss
adviser can save 10 minutes of consultants’ time per patient.
Treatment compliance
Sight loss advisers have a good understanding of a range of eye
conditions and can help patients to understand and manage their
condition, comply with treatments and promote self-care to enable
the best possible chance for medical interventions to be
successful. For example, they support glaucoma patients to
understand the importance of taking their eye drops to prevent
avoidable sight loss. RNIB research shows that 71 per cent of
patients said they had a better understanding of their eye condition
after contact with a sight loss advisor [4].
Processing Certificates of Visual Impairment (CVI)
For a patient to be eligible for registration a Certificate of Visual
Impairment must be completed and sent to the local authority. The
local authority should then make contact to arrange an assessment
for rehabilitation training and aids and adaptations to support
independent living. The lack of an ECLO in some major eye
departments has been identified as a barrier to patients being
certified [5].
Provision of high quality support, information and
advice
Sight loss advisers carry out a holistic review of a patient’s needs
to provide a tailored service. This can involve providing emotional
support and advice to distressed and vulnerable patients.
They improve patient experience through helping individuals to
adjust to their sight loss and maintain their quality of life. Sight loss
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advisers promote independence by informing patients of their
rights, available services, entitlement to welfare benefits,
employment advice and community support groups. Findings show
that 74 per cent of patients either strongly agreed or agreed that
they felt more optimistic about the future, due to the support of an
ECLO [4].
Investment cost of a sight loss adviser
The cost of investing in a full time sight loss adviser (35 hour perweek post) for 3 years is £120,000 (£35-40k per annum).
Growing need for a sight loss adviser
Increasing numbers of people with sight loss
The UK population is ageing, with the number of people over the
age of 85 increasing the most. A clear relationship between ageing
and sight loss means the number of people with sight loss is
expected to increase significantly. There are currently almost two
million people in the UK living with sight loss and by 2020 this is
predicted to increase by 22 per cent, and is set to double to almost
four million by 2050 [6]. Sight loss advisers can support eye
departments to manage with the increasing numbers of patients by
dealing with the non-medical interventions.
See the RNIB Sight Loss Data Tool for further local information.
Rising costs of sight loss
The costs of eye care are increasing year on year with an ageing
population. The total cost of sight loss to the national UK economy
is nearly £8 billion a year [7]. £2.64 billion is accounted for by direct
costs such as hospital care, including inpatient admissions and
outpatient appointments, along with expenditure on medications
and prescriptions. Indirect costs amount to £5.3 billion, and include
unemployment, the burden on family and the provision of informal
care.
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Sight loss advisers can provide real cost savings to eye
departments by supporting independent living, self-help and by
reducing the potential for further deterioration in eye health, falls
and mental illness.
Strategic fit of sight loss advisers
The following frameworks and sources of information provide some
general information to support the case for a sight loss adviser
service. For detailed knowledge about the strategic fit and relevant
local drivers to support the development of this service please
contact RNIB or Action.
NHS Outcome Framework and Adult Social Care
Framework
Sight loss advisers enhance patients’ quality of life by improving
the effectiveness of post-diagnosis care by helping people to
maintain independence. The support service also contributes to a
positive patient experience through an emphasis on the integration
of health and social care services.
Public Health Outcome Framework
This framework includes a ‘preventing avoidable sight loss’
indicator. Sight loss advisers support this through providing eye
health care and information and helping to increase treatment
compliance.
Other local priorities and information that will support the case for a
sight loss adviser:
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CCG priorities
NHS Trust priorities
Public Health priorities
JSNA evidence
Health and Wellbeing Board priorities
Local Eye Health Network evidence
Local society evidence
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Care Quality Commission reports and recommendations
Royal College of Ophthalmologists guidance
NICE guidance
RNIB’s sight loss data tool
Patient experience feedback
Support to develop a business case
For specific guidance and support to build a local case for a sight
loss adviser service, please contact RNIB:
Email [email protected] or phone 020 7391 2123
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References
[1] Sital Sing, P. Economic Impact of Eye Clinic Liaison Officers: A
Case Study – Full Report. July 2013. RNIB
[2] Boyce, T. Falls – costs, numbers and links with visual
impairment. August 2011. RNIB.
[3] Scuffham P, Chaplin S, Legood R. Incidence and costs of
unintentional falls in older people in the United Kingdom. Journal of
Epidemiology and Community Health, 57:740–4. 2003.
[4] RNIB. ECLO impact tool: early findings. March 2015.This figure
is based on 315 responses to a patient experience questionnaire.
[5] May, H. et al. Evaluation of the Certificate of Vision Impairment
(CVI) Workshops. September 2014.
[6] Access Economics 2009. Future Sight Loss UK 1: Economic
Impact of Partial Sight and Blindness in the UK adult population.
RNIB.
[7] RNIB. Sight loss UK 2013: the latest evidence. May 2013.
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