See Hear: A strategic framework for meeting the needs of people with a sensory impairment in Scotland

5. National policies and practice expectations

5.1. The Scottish Human Rights Commission has identified Human Dignity and Care, and Human Rights in Healthcare as being amongst its key priorities, and a wide range of Scottish Government policies and guidelines have emerged over the last few years that have addressed a variety of issues across the health and social care agenda. These have all sought to focus on changing outcomes for service users. The forthcoming integration of social and health care services for adult care is similarly focused on improving outcomes. This integration agenda and the Reshaping Care agenda recognise that increased need in the context of diminishing resources can only be met through the introduction of different ways of responding to need and delivering support. While none of these policies and initiatives specifically relates to sensory impairment, they all have relevance to people with a sensory impairment.

5.2. The emerging themes include:

• A strong emphasis on an outcome focused approach that understands that the active engagement of the service user and their carers is the best means of ensuring effective outcomes in the planning and delivery of care;
• An acceptance of the importance of a redirection of resource towards more targeted preventative strategies that promote healthy lifestyles and the provision of information and advice to assist with this, both in general terms and also in relation to specific conditions;
• Early diagnosis and intervention (assisted by screening programmes) and the provision of information and signposting to people and their carers around the time of diagnosis;
• The need to facilitate greater flexibility in the support provided to people. This should be underpinned by greater choice and control for individuals, coupled with an emphasis on facilitating informed choice through good quality information and advice;
• The promotion of greater support to people, including the provision of appropriate community equipment, to assist them to manage their own lives, particularly with regard to long term conditions, in a way that maximizes independence and self care, with appropriate support and guidance as required, and the development of community capacity to support local responses to identified needs;
• Clear care pathways across a range of conditions that encourage and guide the individual through their engagement with assessment processes and service provision, and support them in managing their own conditions, including targeted support to people at time of transitions;
• The need to ensure effective and efficient joined up working across the public, third and independent sectors, with a drive to minimize duplication and encourage the sharing of information across and within agencies and effective partnership approaches with service users and carers;
• A skilled and well trained and supported workforce;
• A robust but proportionate means of measuring performance that concentrates on beneficial outcomes for service users and carers.

5.3. The above issues all apply to people with a sensory impairment and represent the essential principles that should guide the development of services.

5.4. A number of national developments help to support these themes, and have implications for people with a sensory impairment. These include Self Directed Support, Reshaping Care for Older people (with funding from the Change Fund), the revision of the National Care Standards, and the implementation of the Carers and Young Carers Strategy.

5.5. Linked to these policies and expectations is the recognition that there is a hierarchy of need that requires a different type of response depending on the level of need. This is reflected in relation to sensory impairment in the diagram below^[9].

5.6. An individual will move between these levels over time, and it is the task of services to ensure that an appropriate response is available, in the context that at all times the emphasis should be on supporting the individual to retain maximum independence consistent with their safety and well being. This can be enhanced by the effective strategic procurement and provision of appropriate community equipment that promotes independence and can link to the developing use of telecare.