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

7. Areas for Action

7.1. As outlined earlier, it is intended that this strategic framework should be a lever for change, and should facilitate that change across agencies and services.

7.2. In the context of the above overview, summary of national policy and practice directions and expectations, and comments on the requirements for an effective care pathway, a number of key issues and areas for action can be identified that lead to a range of broad recommendations.

7.3. These areas for action and recommendations are outlined below. It is intended that the consultation process will allow for comment to be made on these matters, and further work will be done to produce more refined recommendations and action points.

Spending patterns

7.4. As outlined in the overview section of the strategy there is a broad context of increasing demand sitting alongside a decrease in available funding. It is therefore important to understand what the current expenditure is against services for people with a sensory impairment, and the extent to which this is reflected in other workstreams, e.g. the Reshaping Care for Older People and Self Directed Support, in order to inform options for future spending patterns.

Recommendation 1

An audit should be undertaken of all current spend on sensory impairment, including that relating to carers, across statutory Health and Social Care and third sector agencies, in relation to specialist provision and also to those elements of other service provision that impact on people with a sensory impairment. In the light of the findings, consideration should be given to options for realignment of spend as appropriate.

Screening for sensory loss

7.5. Stakeholders repeatedly stressed the centrality of effective assessment and diagnosis. This is the initial point of identification of sensory loss. Timeous diagnosis leads to speedier, and often more helpful, treatment and support, the introduction of Universal Newborn Hearing Screening being a good example of this, whereby screening for hearing loss at birth can lead to earlier intervention. Sensory loss, however, can often have a slow onset and individuals may not be aware that their loss is increasing, or may feel reluctant to ask for assistance. As outlined earlier there is also the important group of people who have, or may have, 'hidden' sensory loss. In addition to specific assessment for sensory loss, as outlined in the Care Pathway diagram earlier, there is also the need to take full account of potential sensory impairment issues in mainstream assessments.

7.6. Simple screening can be undertaken by a range of staff that could identify potential sensory loss and lead to appropriate onward referral. Such screening could be undertaken when the person reaches an agreed age, or at key times of engagement, e.g. as a routine part of health or social care assessments.

Recommendation 2

Local partnerships should consider options for the introduction of basic sensory screening, for example, for people of a certain age, and at agreed times in their care pathway.

Awareness of issues relating to sensory loss

7.7. Discussion with stakeholders revealed a clear view that there is a lack of awareness of sensory impairment issues in staff across a range of services that can have a direct impact on the appropriateness of care plans for some people, and the ability of some staff to provide simple solutions. Local initiatives in care settings (such as the provision of sensory impairment awareness training and the introduction of tools to assist in care planning) have provided positive results in staff awareness and on the impact this has on the quality of care planning that takes into account the impact of sensory loss for people. The view was strongly expressed that this is particularly important for staff who work with older people, e.g. community nursing staff, home carers, care home staff, occupational therapists and community based health professionals.

Recommendation 3

There should be mandatory training in sensory awareness and assessing for non complex needs across staff in health and social care settings, targeted in the first instance on older people's services.

Promoting effective local service provision

7.8. The role of care pathways is now recognised in relation to the provision of a more integrated and positive experience for the individual, but also as a way of optimizing resources and systems for agencies that assist in the provision of the most efficient service patterns. They are in place across Scotland for a number of long term conditions, but not so far in relation to sensory loss.

7.9. Local services are organised in different ways to reflect local circumstances, but all local areas should be able to demonstrate that they have planned for services that reflect local need, that promote partnership working, that provide clear integrated care pathways for individuals, and that also promote prevention, self help and self management of sensory loss wherever possible.

7.10. Current policies across across community health and social care services reflect the increasing emphasis on providing greater support to people to manage their own conditions, and to have greater choice and control over their support in a way that maximizes independence and self care, with appropriate support and guidance as required. This requires there to be good information available about sensory loss, its impact across a number of areas for individuals, and ways in which people can be assisted to manage their sensory loss.

Recommendation 4

Local partnerships (in this instance local statutory social and health care agencies, and third sector agencies) should be able to evidence that their service planning reflects the need in their area.

They should develop care pathways for people with a sensory impairment, which confirm the component parts of the individual's journey. In so doing they should assess performance against the care pathway and the key factors for effective pathways outlined earlier, and use this as the basis for service improvement, and identify the relevant responsibilities across agencies for the delivery of this.

Accessible local information strategies should be developed to include preventative measures and good self care in retaining sensory health, but also providing information on how to access services.

The above matters should be subject to regular reporting and review by local partnerships. The Scottish Government will provide funding to local partnerships for 2013/14 and 2014/15 to assist with the work that will be required to implement this group of recommendations. Partnerships should ensure that attention be given to ensuring maximum sustainability once this funding ceases.

Data collection

7.11. As highlighted in the section on the development of care pathways, reliable information is basic to understanding the prevalence of sensory 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. Currently there are no standard expectations in this regard.

Recommendation 5

There should be robust systems for maintaining information locally, and sharing this between agencies, in relation to people who have received a diagnosis of a sensory impairment at any time from birth onwards.

Barriers to everyday life

7.12. As outlined in the overview section of the strategy, people with a sensory impairment face a number of barriers to participation in everyday life, particularly in relation to how they are able to communicate with the world around them. The Equality Act 2010 brings together a number of pieces of legislation into one single Act to help tackle discrimination and inequality. The view was expressed from stakeholders that people with sensory loss may not have benefitted from the provisions of the Act to the same extent as others.

7.13. It would be a helpful exercise to consider the extent to which the provisions of the Act have application to people with a sensory loss. This will result in a potential range of issues, both legal and practical, that require to be addressed, and that will then require consideration for further action.

Recommendation 6

Compliance with the Equality Act 2010 should be scrutinised in relation to sensory impairment, particularly in relation to communication, and consideration given as to what future action may be required.