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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. rnib.org.uk 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 rnib.org.uk 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. rnib.org.uk 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: CCG priorities NHS Trust priorities Public Health priorities JSNA evidence Health and Wellbeing Board priorities Local Eye Health Network evidence Local society evidence rnib.org.uk 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 rnib.org.uk 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. rnib.org.uk