See Hear

8. Areas for Action

8.1. 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.

8.2. 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.

8.3. These areas for action and recommendations are outlined below:

Sensory loss checks

8.4. 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.

8.5. 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, including community care assessments.

8.6. Early identification of sensory loss can have a positive impact in reducing negative outcomes (e.g. it could reduce the risk of falls). To assist this, simple checks can be undertaken by a range of staff that could identify potential sensory loss and lead to appropriate onward referral. Such checks 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 1:

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

Awareness of issues relating to sensory loss

8.8. 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 the consequent 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 2:

At a national level, the Scottish Government should scope out the range of formal and informal training opportunities around sensory impairment awareness, and work with the relevant education, training and qualification bodies to explore opportunities to increase awareness and expertise in the area of sensory impairment awareness, building appropriate content into the core training regimes of different professional groups.

Recommendation 3:

Local partnerships should audit their skills base in relation to awareness of sensory impairment in the workforce and take steps to address any deficits identified, targeted in the first instance at older people's services.

Promoting effective local service provision

8.9. 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 optimising 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.

8.10. 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 self-help and self-management of sensory loss wherever possible. Children's service planning, as strengthened through proposals in the Children and Young People (Scotland) Bill, will bring service providers together into a single, integrated planning system. These published plans will provide information on how children's needs will be addressed through an integrated approach; promoting, supporting and safeguarding their wellbeing and making the most efficient use of available resources.

8.11. Current policies across community care 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 maximises 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:^[13]

Local partnerships (in this instance local statutory and third sector agencies) should be able to evidence that their service planning reflects the need in their area, and reflects appropriate responses to the hierarchy of need outlined earlier.

They should audit current spend and service patterns on sensory impairment, including for carers, 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 service redesign as appropriate;

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.

Data collection

8.12. 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

8.13. 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 Equalities 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 benefited from the provisions of the Act to the same extent as others.

8.14. The UN Convention on the Rights of Persons with Disabilities (UNCRPD), particularly Article 9 on Accessibility refers to providing accessible information, support and assistance as required to ensure disabled people are treated equally and fairly.

8.15. It would be a helpful exercise to consider the extent to which the provisions of the Act and the Convention have application to people with a sensory loss, and to determine whether there are issues that require to be addressed and that will then require consideration for further action.

Recommendation 6:

Agencies should review their compliance with the Equality Act 2010 and the UNCRPD Article 9 in relation to sensory impairment, particularly in relation to communication, and give consideration to whether any future action may be required.

Children and young people

8.16. This strategic framework is designed to apply to children and adults. It is however recognised that the current work in taking forward the Doran review, and the progress of the Children and Young People (Scotland) Bill through the parliamentary process, will have a significant impact on how developments will be taken forward for children with a sensory impairment. The detail of this will be influenced by the above work.

Recommendation 7:

The Scottish Government should issue further guidance in relation to children and young people following the conclusion of work on the implications of the Doran review and the eventual enactment of the Children and Young People (Scotland) Bill.