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

6. The development of care pathways

6.1. Another way of considering the response that should be made to sensory loss is to consider the ways in which an individual person's journey, or care pathway, will require well considered interventions from statutory agencies and service providers.

6.2. Care pathways are increasingly seen as a means of ensuring that local partnerships and services have clearly identified and agreed ways of assisting the individual to move through and across services for particular conditions. Not only does this provide a more integrated and positive experience for the individual, but it is also a way of optimizing resources and systems for agencies to provide the most efficient service patterns.

6.3. Every person's needs are different and there can be no typical journey, but the diagram below has been designed to show the main component parts of most people's journey in relation to sensory impairment. Again people may enter at different stages, particularly in relation to the nature of the onset of a sensory impairment. This journey recognises that many people can be dealt with through mainstream service provision. If these services, and staff within them, have an awareness of the needs of people with sensory loss then a wide range of these staff should be able to not only identify needs relating to sensory impairment, but also assess and provide simple solutions. It also recognises, however, that there will be some people whose sensory loss or complexity of need is such that specialist provision will always be required.

6.4. Carers and other family members can often be the first to recognise a sensory loss in a family member. As such they are a valuable source of knowledge and expertise. Recognising the challenges of sensory loss, carers can also be assisted to support people with a sensory loss if they are aware of the implications of that loss and, where appropriate, are provided with information that can assist them in their role as carers. In many instances the person themselves will be able to relay this information, but in other instances it would be helpful if this could be done either directly with the carer, or with both the person themselves and their carer.

6.5. Meeting the communication needs of people with a sensory impairment is fundamental to ensuring that they can engage with the care pathway, and is an essential element in their everyday lives as part of the care pathway.

6.6. Care pathways provide a framework around which services can be coordinated in response to changing need. They provide a structure to guide interventions and to prompt actions and communication between and within agencies and services. Pathways will, however, require to be confirmed at a local level to take account of local circumstances, while reflecting the main elements outlined in the diagram.

6.7. To ensure that pathways work as effectively as possible for people with a sensory impairment there are a number of key factors that must be in place at a local level.

• It is important that referral routes into support services are clear to those undertaking diagnoses, and that information is available in appropriate formats to the individuals themselves. For the majority of people, the point of diagnosis will be undertaken primarily through NHS Audiologists, ophthalmologists, optometrists or independent optometry practitioners. Others will first become engaged through their GP;
• It remains a cause for some concern that there is no standard set of expectations in relation to maintaining information in relation to people with the various diagnoses of sensory impairment. Such information is basic to understanding the prevalence of impairment and then being able to monitor the reach of services, engage with service users and carers, identify and learn from best practice, and identify gaps and opportunities for service improvement;
• A commitment to the consideration of sensory impairment being included in generic assessments, and development of integrated service provision that actively promotes opportunities for assessment and service provision across both the different types of sensory loss and also the agencies involved: in some areas, this could build on recent One Stop Services activity. Agencies and disciplines should have robust, coordinated arrangements for information sharing and a commitment to local care pathways to best meet the needs of local service users. They should be aware of the opportunities offered by their distinct legal and practice frameworks, and to take advantage of any such opportunities to provide person centred solutions for individuals;
• A commitment to maximise basic screening for sensory impairment, which can readily be undertaken by non specialist staff, with onward referral where there is an indication of sensory loss. This could be done at GP surgeries when the person reaches an agreed age, or at key times of engagement, e.g. assessment for other community care services or admission to a care home;
• A commitment to a single point of access wherever possible, including for ongoing contact. This places a responsibility on services and agencies to work together effectively and reduce duplication and confusion for the individual;
• A clearly developed set of local sensory impairment care pathways that are agreed by key stakeholders and understood by all clinicians, assessors, service providers and, most importantly, the person themselves. This should address the needs of people with an identified sensory impairment, people at risk of sensory loss, and people who may be living with a hidden sensory loss, and should reflect the importance of prompting the outcomes based approach outlined earlier;
• A commitment from statutory agencies to seek to agree the maximum possible consistency of approach across Scotland, and ensure similar access to services across Scotland;
• A commitment to awareness raising training for front line staff who may have to deal with people with sensory impairments.

6.8. It is important to acknowledge that there are some groups within the world of sensory loss for whom that loss provides additional challenges both to them and to services who are seeking to provide integrated care pathways:

People with a learning disability

6.9. People with a learning disability are more likely to have a hearing loss, and are 10 times more likely to have a sight loss than people in the wider community. This can have a profound impact on how they are understood and are able to interact with others, and people with challenging behaviour will be more likely to challenge if there is a limited understanding of any sensory loss that they may have.

Older people

6.10. It is now well understood that people are living longer, and consequently there is an increasing incidence of those illnesses and disabilities that increase with age. This strongly applies to hearing and sight loss (see figures earlier). The impact on an older person who may already be finding it less easy to continue with previous lifestyles can be very significant. Yet it is still the case that hearing or sight loss is often not recognised or responded to by caring agencies, including home carers, hospital or care home staff.

Hidden and untreated sensory loss

6.11. Hidden and/or untreated sensory loss leads to a withdrawal from social interaction. Sensory impairment is a major contributory factor in falls, and subsequent admission to hospital, which is the major contributory factor to admission to a care home. To a person with dementia, failure to recognise and respond to a sensory loss will result in greater isolation, will generate behaviours that can be misinterpreted as symptoms of advancing dementia, and will lead to a consequent failure to respond appropriately to basic physical needs.

6.12. Included within the groups above, there will be people who are seeking work or are engaged in work. For these people the impact of a sensory loss can have significant implications for entering work, retraining, and being supported to stay in work.