PAGE 4 | THE CARER DIGITAL | ISSUE 70
What The Social Care Sector Can Do To Address Poor Eye Health By Laura Wood, QCS, Clinical, Mental Health and Learning Disabilities Specialist (www.qcs.co.uk) The COVID-19 pandemic has affected our health in a myriad of different ways. According to the REACT-2 Study, for example, over two million people in the UK may have suffered from Long Covid. But, COVID-19 has also taken a toll on our eyes. Exactly how much is impossible to quantify. However, to mark National Eye Health Week 2021, a recent report commissioned by Deloitte Access Economics says nearly 3,000 people on these shores have lost their vision during the pandemic. Part of the reason is the number of NHS eye appointments that were cancelled during the crisis. The Deloitte Access Economics study says that there were 4.3 million fewer eyes tests carried out in the pandemic. That’s 23 percent fewer examinations than normal. Maintaining eye health in the social care sector COVID-19 has been particularly unkind on service users in social care, some of whom rely on regular eye tests. As a disabilities specialist and a Registered Nurse, while I am not an expert in eye health, I’ve worked with a range of different age groups, across a raft of settings for over 21 years. During this unprecedented crisis, I’ve witnessed first-hand the challenges that Registered Managers face to ensure that those they support receive the best eye care possible. An inability to visit an optician during lockdown, or for an optician to conduct a home appointment for those confined to a residential home, has proved devastating for a multitude of service users. In some cases, but not all, it has led to “delayed identification and treatment for eye disease” as the Deloitte Access Economics study points out. But it is not just older people in residential care who require regular check-ups. Statistics published by the RNIB, a leading sight loss charity, show that one in ten people with learning disabilities also have “significant eye loss”, while six out of ten need glasses.
PROVIDING THE RIGHT SUPPORT It is vital, therefore, that Registered Managers are able to seek out the support that their service users need. I can foresee a number of obstacles on the horizon, however. Currently, albeit at a local level, I am working with a GP federation to establish all of the staff in a surgery – or working with it – that are responsible for visiting care homes. While I don’t have any data to share, the first major barrier, will inevitably come on November 11 when any optician visiting a care home will need to provide evidence to the Registered Manager that they have been fully vaccinated against COVID-19. The problem is that across the UK, nobody seems to know how many opticians have received both vaccinations, and I think it's something that will only be established when the new legislation comes into force. While I don’t wish to make any predictions, I do think it is likely that the pool of opticians currently able to visit care homes will decrease. By how much, however, is the million dollar question. To overcome this potential issue, there are a number of action points that Registered Managers can take. They can check care plans to see when service users last had an eye test. From a best practice perspective, if eye appointments are held annually and a service user is due a test after November 11, frontline managers could arrange the test to take place before November.
THE IMPORTANCE OF CUTTING-EDGE CONTENT AND ROBUST POLICIES Quality Compliance Systems (QCS), the leading provider of content, guidance and standards for the social
care sector, has developed a range of digital care plans, which are directly linked to QCS’s policies and procedures. This enhanced content delivery system enables frontline managers to provide care staff with the right tools at the right time to ensure that they provide outstanding care. The health action planning policy is particularly effective because it details the information that should be recorded to support a person with learning disabilities in accessing the right health support, which includes regular eye appointments. But, there are many service users who suffer from complex eye conditions, which require regular hospital check-ups with experienced ophthalmologists. Again, with a government consultation currently taking place, which will determine whether all health and care staff in England should be vaccinated against COVID-19 and flu this year, there are many known unknowns as to whether it is likely that NHS eye appointments will be affected. In the event that they might be, Registered Managers, should have a contingency plan in place, which would help them - and the service users they care for - cope with a shortfall in appointments.
FORMING CONTINGENCY PLANS When eye check-ups have been cancelled or postponed, frontline teams should also closely monitor service users for any tell-tale signs that their eye-sight might be worsening. Has the individual suddenly begun to suffer trips, slips or falls, for instance? Can they read their book or magazine, or recognise the birds in the care home garden? Have they experienced pain, nausea, cloudy or blurred vision? Care and support workers need to note and collate this information in service plans and report any major issues to a local GP straight away. But it isn’t quite as simple as that. Why? Well, take a person living with dementia, for example. They may notice a change in their prescription, or even if they did, it may be hard for them to communicate it to their carer. Therefore, it is up to professional carers to observe them closely and try to pick up on any subtle differences, record and log them in care plans and keep in regular contact with eye health professionals.
HELPING SERVICE USERS AT HOME TO MAINTAIN GOOD EYE HEALTH In different settings, carrying out such evaluations isn't always easy – particularly in domiciliary care. Home care appointments, while extremely thorough, are often short. In a quarter of an hour or a half an hour slot, a professional domiciliary carer often only has time to meet a service user’s basic needs. However, that said, an experienced and well-trained professional who carries out daily visits should be able to detect if something is not quite right with a person’s eyesight. If they do detect a problem, there are several specialist opticians that are set-up to carry out eye tests in a home environment that Registered Managers can contact.
TAKING THE FEAR OUT OF AN ANNUAL EYE CHECK For those with learning disabilities, the challenges are slightly different. Many are able to visit an optician, but sometimes are nervous about having their eyes tested - especially if an examination involves applying eye drops, which can be uncomfortable. There are a number of approaches, however, that care and support workers can take to make this experience more comfortable for service users. They can mentally prepare them for an appointment by gently talking to them daily – starting a couple of weeks in advance - about the eye appointment. Desensitisation techniques might possibly involve showing them pictures of the optician, the practice, the equipment that will be used and even the shop front on the high street where the eye exam will take place. This, and the other examples that I have mentioned, serve to remind us of the invaluable role that frontline care staff play in helping service users to maintain eye health. Care professionals may not be opticians or ophthalmologists, but they add great value. In National Eye Health Week, perhaps we should recognise and thank them for their unheralded work which so often goes under the radar. To find out more about QCS or to purchase a subscription, please click on the following link or contact QCS’s team of advisors on 0333-405-3333 or email: sales@qcs.co.uk.
VODG Survey Reveals Extent of Workforce Concerns Among Disability Charity Leaders A survey of Voluntary Organisations Disability Group (VODG) members has unearthed stark findings – all the survey’s Chief Executive respondents were found to be ‘not confident’ that the Government’s plan for social care reform will address the huge problems surrounding staffing challenges their organisations face. The survey findings reveal the perfect storm the layering of Covid 19, Brexit and mandatory vaccinations could have on the continuation of delivery of safe and effective services delivered by charities within the disability sector. A fifth of responding organisations reporting more than 100 vacancies within their service. A total of 3,500 vacancies were reported across all organisations. The research carried out by VODG, a membership body of more than 100 organisations that work alongside disabled people, gathered the views of member chief executives, who across the whole survey employ 43,774 full-time staff, 32,561 of which work in first line support roles, about the current workforce challenges facing their organisation. Addressing workforce challenges is a key priority for 94% of respondents, who cited it as a ‘top’ or ‘high’ priority. For the majority, the recruitment and retention of staff continues to be a significant issue, with recruiting new members of staff of particular concern. More than two thirds found that recruitment of staff has got much more difficult since the emergence of the coronavirus pandemic. Some reported seeing an increase in turnover alongside a reduction in applications for front line roles. This, for many, is leading to concerns about sustaining high quality care for the disabled people they support. A quarter said they are not very confident or not at all confident in having
sufficient staff to deliver current and planned future services. In the past 12 months, 11 organisations have handed back service delivery contracts, with some citing insufficient staff as a reason. Dr Rhidian Hughes, Chief Executive of VODG, said: “Disabled people rightly expect to use high quality services, and there is a risk that their support options, and the quality, could very quickly become compromised if these workforce challenges are not urgently addressed. “The Government must urgently make funds available for the sector, with a significant proportion of that ring-fenced for pay uplifts for care workers. We want to see social care commissioned, as a minimum, at Real Living Wage rates.” The survey also addressed additional workforce issues including local authority funding, the impact of the UK’s exit from the European Union and the mandatory COVID-19 vaccination for care home workers. Many of the responding organisations felt that workforce issues will be exacerbated by new regulations requiring that all staff working in CQC registered care homes have received two doses of the COVID-19 vaccination as a condition of deployment. Furthermore, providers believe that the ongoing workforce pressures will place additional strain on remaining employees and will increase the likelihood of absences and wellbeing issues. Dr Hughes added: “The findings of our survey reveal the far-reaching extent of concerns amongst chief executives of disability charities. Our membership is a broad and diverse group of organisations, all of which has been delivering services to disabled people under challenging conditions over the past 18 months. Our survey clearly shows the stark reality many are facing, with a layering of issues that together
could compromise the delivery of safe and effective services. Mandatory vaccinations are driving a small but significant group of carers away from the sector, the supply of EU workers is drying up, and insufficient funding from central government means that the majority of local authorities continue to commission care at minimum wage rates. “Competition across low pay sectors is intensifying and when services are commissioned on minimum wage it is impossible to improve terms and conditions. Members reported that fees received from local authorities simply do not cover the direct costs of providing care and we have now reached the point where they can no longer subsidise contracts. It is simply unacceptable that should have to subsidise contracts in the first place, but a growing lack of provision will be felt by those who need it most. “The government has options available. We need to continue to encourage vaccination take up across the sector and could consider incentives. “It’s also imperative that the government understands that social care is so much more than washing, dressing, and helping people have their meals. Care and support services for working age disabled adults enable people to live independent and fulfilling lives. “Government’s reform agenda must go a lot further and must include a stronger focus on long-term sustainability of services to meet growing demand, supported by investment in helping the sector to secure a high-quality workforce – one that is grounded in the perception that a career in social care is fulfilling, inspiring and well rewarded.”