Post on 17-Oct-2020
Wales Eye Clinic Liaison Service Impact Report
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Contents1.0 Introduction 5
1.1 Thechallenge 5
1.2 TheWaleseyeclinicliaisonservice 5
1.3 Thepolicycontext 6
1.4 Summary:benefitsoftheeyeclinicliaisonservice totheNHSinWales 6
2.0 TheroleoftheEyeClinicLiaisonOfficer(ECLO) 8
3.0 Thebenefitsoftheeyeclinicliaisonservicetothe NHSinWales 11
3.1 Ophthalmology 11
3.2 Fallsprevention 12
3.3 Mentalillhealth 12
3.4 Poverty,unemploymentandimpactonphysical andmentalhealth 13
4.0 Conclusion 15
Appendix1 Eyeclinicliaisonservicepartners 16
Appendix2 Waleseyeclinicliaisonserviceandfunders 17
References 18
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1.0 Introduction
1.1 The challengeWiththenumberofpeopleintheUKwithsightlosspredictedtodoubleby2050(1),findingwaystoreducetheeconomicimpactandrelievepressureonhospitaleyeclinicsisanurgentpriority.
•AlmosttwomillionpeopleintheUKarelivingwithsightloss(2).
•HealthcareexpenditurelinkedtoeyehealthinWalesisnearly£120millionayear(3),buttheindirectcosttotheeconomyismorethandoublethisamount(4).
1.2 The Wales eye clinic liaison serviceTheWaleseyeclinicliaisonservice,developedbyRNIBandpartnerorganisations(seeAppendix1forpartnerinformation),aimstoreducerisktothepatients’physicalandmentalhealth,andincreasetheirabilitytolivesafelyandindependently.Theserviceprovidesessentialemotionalsupportandpracticaladviceatthepointofdiagnosisofsightloss,providinganeffectivelinkbetweenhealth,socialandcommunitysupportservices.
TheeyeclinicliaisonserviceinWalessupported6,730patientsin2012/13.
Thecriticalroleoftheeyeclinicliaisonserviceiswidelyrecognised.EyeclinicliaisonservicesareincludedintheWelshGovernmenteyecarepathwaysforAgeRelatedMacularDegenerationandGlaucoma.TheRoyalCollegeofOphthalmologyrecommendsthatEyeClinicLiaisonOfficers(ECLOs)arepartofaminimumserviceteam(5).
EyeclinicliaisonservicesinWalesarefundedbyBetsiCadwaladrHealthBoard,theBIGLottery,RNIBCymru,CardiffInstitutefortheBlind,andSightCymru(seeAppendix2forserviceandfundingdetails).ThethirdsectorhasprovidedsignificantinvestmentandpumpprimingtoensureservicesareavailabletopatientsacrossWales.Thisfundingistimelimitedandserviceswillbeatriskinthenext18months.
Thefutureprovisionofthiscriticalserviceisatrisk.
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1.3 The policy context TogetherforHealth,theWelshGovernment’sfive-yearvisionfortheNHS,focusesonreducedhealthinequalities,improvedaccesstoservices,animprovedpatientexperience,andprovidinghighqualitycare.
TheWelshGovernment’sdraftEyeHealthCarePlanforWalessetsoutfiveobjectivesinrelationtoeyehealth:
•Preventingpooreyehealthandvisualimpairment.
•Improvingeyehealthoutcomes.
•Ensuringearlyidentificationandintervention.
•Providinghighquality,efficientservices.
•Ensuringpatientfocuseddeliveryofintegratedservices.
TheeyeclinicliaisonservicesupportsdeliveryofWelshGovernmentobjectives.Byprovidinginformation,advice,emotionalandpracticalsupporttopatientsinatimelyfashion,theserviceimpactspositivelyonpatients’healthandwellbeing.ECLOsareanefficientandeffectivelinkbetweentheeyeclinicandthewidersupportandserviceswhichpeopleneedtolivewellwithsightloss.
1.4 Summary: benefits of the eye clinic liaison service to the NHS in WalesWhenpeoplemanagetheirconditionsthemselvestheyimprovetheirqualityoflifeandthisreduceshealthcarespendinginthelonger-term.Theeyeclinicliaisonservicecanmeettheneedsofthoselivingwithlong-termconditionsbyofferingsupportforself-careandencouragingindependence.
Theserviceincreasestheefficiencyofclinicalstaffthroughenablingthemtofocustheirtimemostappropriately.Thisisachievedthroughreducingthetimeclinicalstaffneedtospendwithdistressedpatients,providingemotionalsupport,assistingwiththeadministrationofCertificatesofVisualImpairmentandprovidinginformationonpatients’eyeconditions.Patientthroughputismaximisedandthestressfeltinclinicscanbereduced.
“FallsareamajorcauseofdisabilityanddeathinolderpeopleintheUK,andresultinsignificanthumancostsintermsofpain,lossofconfidenceandindependence”(6).ECLOsprovideinformationonfallpreventionandsupportpatients’timelyaccesstolowvisionandrehabilitationservices.Thereisasignificantfinancialcosttohealthand
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socialcareservicesassociatedwithdealingwiththeresultsoffalls(7).Helpingreducepatients’riskoffuturefallscanreducetheconsequentcosttotheNHSandSocialServices.
TheAllWalesMentalHeathNetwork’s2010reportestimatedthecostofpoormentalhealthinWalestobemorethan£7.2billionperyear.Olderpeoplewithsightlosswholivealonearethreetimesmorelikelytoexperiencedepressionthanthosewithnormalsight(8).Theeyeclinicliaisonserviceprovidesessentialemotionalsupportatthepointofdiagnosisandsignpoststosocialandcommunitysupportservices,helpingthepatientadjusttolivingwithsightloss.
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2.0 The role of the Eye Clinic Liaison Officer (ECLO)
TheserviceprovidedbytheECLOisperson-centredemotionalandpracticalsupporttailoredtotheneedsofthepatient.Thisisprovidedatanoftentraumaticandvulnerabletime.
Supportcaninclude:
•providinginformationonthepatient’seyeconditionandongoodeyehealth
•referraltotheLowVisionServicetoenablepatientstomakebetteruseofexistingsight
•referraltostatutoryservicesincludingsocialservicesandrehabilitationservices
•adviceonfallspreventionandsafetyinthehome
•adviceoncertificationandregistrationandsupportincompletingtheCertificationofVisualImpairment
•referraltospecialistservicessuchasRNIBCymru’swelfarerightsadviceservice,employmentservice,oreducationandtransitionsservicesforchildrenandyoungpeople
•referralstolocalandnationalvoluntaryservices,includinglocalsupportgroups
•informationonproductsandequipmenttosupportindependentlivingandpersonalsafety
•supportandinformationforfriends,familyandcarers.
Whenpeoplemanagetheirconditionsthemselvestheyimprovetheirqualityoflifeandthisreduceshealthcarespendinginthelongerterm(9).ECLOsmeettheneedsofthoselivingwithlong-termconditionsbyofferinginformation,adviceandsupportforself-care,andencouragingindependence.
PatientfeedbackontheRNIBCymrueyeclinicliaisonservice:
•98percentfelttheircontactwiththeECLOhelpedthemtounderstandwhatothersupportandinformationisavailabletothemoutsideofthehospital.
•88percentthoughttheyhadabetterunderstandingoftheireyecondition.
•67percentsaidtheyhadabetterunderstandingofwhatthingstheycoulddotocareforandtreattheireyecondition.
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Case studyMrDhasage-relatedmaculardegeneration(AMD)andrestrictedmobility.AftermeetingwiththeECLOanumberofissueswereidentifiedthatimpacteduponhishealthandabilitytomaintainindependentliving.Referralsweremadetothefollowingservices:
•RehabilitationOfficerfortheVisuallyImpaired.
•Occupationaltherapy.
•SocialWorkerfortheHardofHearing.
•ITProjectOfficer.
•WelfareRightsOfficer.
ThroughtheworkoftheECLOandthroughcontactwiththeseservicesmanyofMrD’sissueswereresolved.Hewasprovidedwithsmallitemsofequipmenttoenablehimtomanagemoresafelyathome.Avolunteerdriverwasfoundtoassistwithshoppingandattendingappointments.Grabrailsandhandrailswereinstalledindoorsandoutdoorstoreducetheriskoffallingandanoccupationaltherapyassessmentwasspeededup.
TheRNIBCymruwelfarerightsservicesecuredHigherRateAttendanceAllowanceof£74perweek,whichalsogaveentitlementtoPensionCreditandCouncilTaxBenefit.
ByseeingtheECLOattheeyeclinicwhenhedid,MrDreceivedthesupportandfinancialassistanceatthebestpossibletimeandnotatatimeofcrisiswhenhisabilitytomanagemayhavedeteriorated.
Thispatient’sexperienceisinsharpcontrasttothemanypatientswhodonotreceiveaservicefromanECLO.Thepatientstoryonpage9isfromtheRNIBreport“LostandFound”(2009)describesavisittotheeyeclinic.
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Judith’s experience“[Afterthefirstappointment]theysaidtheywouldphoneontheMonday
ortheTuesday,andtheydidn’t.Theysaidtheyhadtakenmyphonenumberdownwrongly...thenexttimeIwentinforanappointmentmyrighteyehad‘gone’.”
Judithwasn’tofferedanyinformationonhereyeconditionorwhatitmeanttoloseone’ssight.Shewouldhavelikedtohavebeenabletotakeinformationawaywithhersosheandherhusbandcouldreferbacktoitintheirowntime.NooneintheeyeclinicspoketoJudithaboutherfeelingsorofferedanypracticaladviceonwhattodonowhersightlosswaspermanent.
“Asfarasthemedicalprofessiongoes,therewasnothing.WhenIwentbacktothewaitingroom,theygavemeacupofteaandleftmewithmyhusband.Iwasleftforawhileonmyown.
“Thereneedstobesomethingineyehospitalssoonafterdiagnosis.Thathastochange.”
Call to RNIB Cymru office – May 2013Aladycalledtheofficesayingthatshehaslostthesightinoneofhereyes.Shewasverydistressedandworriedaboutcompletelossofsight.Shehadreceivednoinformationoradvicefromthehospitalsthatshehasbeenattending,norhadshebeenreferredontotheECLObytheclinic.
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3.0 The benefits of the eye clinic liaison service to the NHS in Wales
Thenumberofpeoplewithsightlossisexpectedtodoubleoverthenext25years(10).ThecostofsightlossinWalesisalreadyestimatedat£370m(11)andhospitaleyeclinicsarestrugglingtocopewithcurrentdemand.Innovativeservicesthatcanhelprelievethepressureonclinicstaffandmitigatetheimpactofsightlossareurgentlyneeded.Theeyeclinicliaisonservicecandothisinanumberofwaysforarelativelylowcost.
3.1 Ophthalmology Inasurveyof15ophthalmologistsallagreedthattheeyeclinicliaisonservicecanincreaseclinicalstaff’sefficiencybyreducingtimespentwithdistressedpatients(12).ThisiscorroboratedbystudiesofeyeclinicliaisonservicesinotherpartsoftheUK(13).
ThesestudieshavealsofoundeyeclinicstaffvaluedtheECLOrolein:
•increasingpatientthroughput/management
•reducingstressintheclinic
•improvingpatients’accesstosocialservices
•assistingwiththeadministrationandprocessingofCertificatesofVisualImpairment
•increasingclinicalstaffefficiencybyreducingthetimespentwithnon-compliantglaucomapatients.
OfpatientsseenbytheRNIBCymruandBetsiCadwaladrECLOs:
•70percentof1,378patientsweregiveninformationandsupportaroundregisteringasblindorpartiallysighted.
•79percentof2,093patientswereprovidedwithinformationontheireyecondition.
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3.2 Falls preventionFallsarecommonlyassociatedwiththeneedforhealthandcommunitycareservices,aswellasadmissiontoresidentialornursingcare.Olderpeoplewithsightlosshave90percenthigheroddsofmultiplefallsthanapersonwithnormalsight(14).Afallcanhaveseriousphysicalandpsychologicalconsequences,aswellassignificantresourceimplicationsforpublicservices.
•Visualimpairmentisdirectlyattributableto47percentofthecostoffallsinthepopulationwithvisualimpairmentand10percentofthecostofallfallsintheUK(15).
•5percentofallfallsleadtoafractureandalmostallhipfractures(92percent)arearesultofafall(16).
•Thecostoftreatinghipfracturesin2005wasestimatedtobe£12,000perpatient(17).
•Whenadmittedforanyphysicalcondition,blindandpartiallysightedpeoplehaveanaveragelengthofstayinhospitaltwodayslongerthanpatientswithnormalsight(18).
OfpatientsseenbytheRNIBCymruandBetsiCadwaladrECLOs:
•25percentof1,007patientssaidthattheyhadhadafall.
•26percentof3,105ofthoseover70saidtheyhadhadafall.
•47percentof1,242saidthattheyfearedafall.
“Byprovidinginformationonfallspreventionandsupportingpatients’timelyaccesstorehabilitationservicestheECLOservicecanhelpreduceapatient’sriskoffuturefalls,andtheconsequentcosttotheNHSandSocialServices.IfadvicefromanECLOpreventedjustoneortwofallsassociatedwithvisualimpairmentthatresultedinafracturedfemur,theECLOservicewouldbecostneutral.”(19)
3.3 Mental ill healthOlderpeoplewithsightlosswholivealonearethreetimesmorelikelytoexperiencedepressionthanthosewithnormalsight(20).Eyeclinicliaisonservicesworkpredominantlywitholderpeople,with90percentofpatientsseenbyRNIBCymruandBetsiCadwaladrECLOsbeingageover50yearsand71percentaged70orover.ECLOscanhelpimprovepatients’mentalwellbeingandreducetherisksassociatedwithpoormentalhealthbyprovidingemotionalsupportatthepointofdiagnosis.Signpostingtootherhealth,socialandcommunityserviceswillhelpthepatienttolivewellwithsightloss.
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•Mentalillhealthisknowntohaveasignificanteconomicimpact,costingWalesanestimated£7.2billionayear(21).
•Nearlyhalfofblindandpartiallysightedpeoplereportfeeling“moderately”or“completely”cutofffrompeopleandthingsaroundthem(22).Thissenseofisolationinevitablyhasanimpactonpeople’smentalandemotionalhealth.
•Sightlosshasbeenidentifiedasoneofthetopthreecausesofsuicideinolderpeople(23).
“Researchevidencesthatprovidingpracticalandemotionalsupporttopeoplewithhealthproblemshasmultiplebenefits–itincreasespeople’scapacitytoself-managetheircondition,improveshealthoutcomes,helpspeopleliveindependentlyandreducestheburdenonthehealthservicebyavoidingunnecessaryhospitaladmissions”(25and26).
OfpatientsseenbytheRNIBCymruandBetsiCadwaladrECLOs:
•76percentof1,755patientslivedalone
•98percentof3,008patientswerereferredtolocalservices
•96percentof2,413patientswerereferredtonationalservices
•90percentof1,920patientsreceivedinformationonlowvisionaids/assessments
3.4 Poverty, unemployment and impact on physical and mental healthTheeffectsofpovertyandunemploymentonbothphysicalandmentalhealtharewelldocumented.Morethanthreequartersofolderpeoplewithsightlossliveinpoverty(25)and66percentofregisteredblindandpartiallysightedpeopleofworkingagearenotinemployment(26).PatientsofaworkingagearereferredontoRNIBCymru’semploymentservice,whichsupportsindividualstoretainorgainemployment.
Manypeoplewithsightlossarenotclaimingthebenefitstowhichtheyareentitled.ByreferringpatientsontoRNIBCymru’swelfarerightsservicetheECLOensurespatientsreceivethefinancialsupporttheyareentitledto.
In2012/13RNIBCymruandBetsiCadwaladrECLOsreferred81percentof1,709patientstotheRNIBCymruwelfarerightsservice.Over60percentoftheindividualsreferredtothewelfarerightsservicewerenotreceivingthecorrectbenefits.Theservicesecuredanaverageof£62.46perweekincreasepersuccessfuloutcome.Thisis£3,247perannum.
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Followupinterviewswithwelfarerightsserviceclientsevidencedthepositivebenefitstohealthandwellbeingarisingfromanincreasedincome:
•68percentofthoseinterviewedreportedanimprovementintheirmentalhealthandemotionalwellbeing.
•68percentofthoseinterviewedreportedanimprovementintheirphysicalhealth,includingfallsprevention.
•65percentofthoseinterviewedreportedanincreasedabilitytobeindependent.
Case study – welfare rights serviceMrandMrsWarearetiredcouple.MrsWhadrecentlybeenregisteredassightimpairedandherhusbandhadextremelypoormobilityduetovarioushealthproblems.
Whenthecouplewerevisitedtheyweresittingintheirloungewhichhadseveralbucketsandcontainersonthefloorastheyhadanumberofleaksintheirroofbutcouldnotaffordtofixit.Theywerestrugglingfinanciallyandemotionally,feelingisolatedandlackingsupportfromfriendsandfamily.Theywerestrugglingduetotheamountofmoneythattheywerepayingoutongenerallivingexpenses,whichhadincreasedduetotheirdisabilities.
WiththesupportoftheserviceAttendanceAllowancewasawardedtobothMrWandMrsW,CarersAllowancewasobtainedqualifyingthemfortwocarers’premiumsontheirpensioncredit,andtheywerealsoawardedtheCoupleDisabilityPremiumRate.Theirincomeincreasedby£288.65perweek.WitharrearsofbenefitsandthesupportofCareandRepairtheywereabletorepairtheirroof,vastlyimprovingtheirlivingconditionsandcomfort.
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4.0 Conclusion Theeyeclinicliaisonserviceishighlyvaluedbypatients,clinicians,socialandcommunitysupportservices.Theservicehelpsmitigatethesocial,emotionalandpsychologicalimpactofsightlossandhelpstoimprovethehealthoutcomesforindividualsandfamilies.TheserviceinWalesassiststheWelshGovernmentinthedeliveryofitsstatedpolicyobjectives.
UniversalcoverageinWalesiscurrentlyunderthreat.Thefutureprovisionofthiscriticalserviceisatrisk.RNIBCymruisnowurgingWelshGovernment,HealthBoardsandotherpartnerstoworktogethertoensurethisvitalserviceisnotlost.
Patient experience“Iwasregisteredsightimpairedanddiagnosedwith‘wet’AMD,myvision
deterioratedquiterapidly,whichwasarealshock.Ialsohaveotherhealthproblems.Ilivealonebutwasveryindependentandthoughtofasastrongindividualwhogenerallysupportedothersratherthantheotherwayround.
“PracticaltasksbecamedifficultandIhadproblemswithmymobilityoutandabout.Ifacedtransportissueswhichweremadeworsebyhavingnofamilylivingnear.
“TheECLOexplainedregistrationandavarietyofsupportservices.Sheprovidedemotionalsupport,referredmetothesensoryteamandarrangedforalowvisionassessmentwithvolunteertransporttoandfromthecentre.TheECLOalsoprovidedmewithcontactinformationonnationalandlocalsupportservicessuchasAgeConcernandRNIB.
“Iwassoveryappreciativeofthesupportprovided.”
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Appendix 1
Wales eye clinic liaison service partner detailsTheBigLotteryAdvantageprogrammefundstheWalesEyePatientAdvocacyService.ThisprojectisledbyRNIBCymruandisdeliveredinpartnershipwith:
•AbertaweBroMorgannwgUniversityHealthBoard
•BetsiCadwaladrUniversityHealthBoard
•BridgeVisSocietyfortheBlind
•CardiffandValeUniversityHealthBoard
•CardiffValeandtheValleysInstitutefortheBlind
•CwmTafHealthBoard
•HywelDdaHealthBoard
•NorthWalesSocietyfortheBlind
•TheRoyalCollegeofOphthalmologists
•VisionImpairmentWestGlamorgan(VIWG)
SightCymruprovideseyeclinicliaisonservicesinAneurinBevanHealthBoard.
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Hospital Weeklyhours Currentfunder
SingletonHospital,Swansea Fulltime RNIBCymru
RoyalGlamorgan,Pontyclun(1day)
YsbytyCwmRhondda,Llwynypia(1day)
PrinceCharles,MerthyrTydfil(1day)
21hours BIGLottery.WalesEyePatientAdvocacyService(ProvidedbyRNIBCymru)
PrincessofWales,Bridgend(2days)
NeathPortTalbotHospital,PortTalbot(1day)
21hours BIGLottery.WalesEyePatientAdvocacyService(ProvidedbyRNIBCymru)
AmmanValley,Ammanford(1day)GlanGwili,Carmarthen(1day)Withybush,Haverfordwest(1day)PrincePhillip,Llanelli(fortnightly)
21hoursintotal
BIGLottery.WalesEyePatientAdvocacyService(ProvidedbyRNIBCymru)
YsbytyGwynedd,Bangor 21hours BIGLottery.WalesEyePatientAdvocacyService(ProvidedbyRNIBCymru)
UniversityHospitalWales,Cardiff Fulltime CardiffInstituteforBlindPeople
RoyalGwent,Newport
NevilleHall,Abergavenny
Parttime,flexiblehours
SightCymru
TheStanleyEyeClinic,AbergeleHospital
4daysperweek
BetsiCadwaladrUniversityHealthBoard
WrexhamMaelor,Wrexham 30hours BetsiCadwaladrUniversityHealthBoardwithsupportfromRNIBCymru
NorthRoadEyeClinic,Aberystwyth NoservicefromApril13
Fundingbeingsought
Appendix 2Wales eye clinic liaison service and fundersTheserviceisprovidedin15ofthe16eyeclinicsinWales.RNIBCymruandtheBigLotteryfundafulltimeWalesECLOManager.
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sightandblindnessintheUKadultpopulation,RNIB
2. AccessEconomics(2009)FutureSightLossUK1:TheeconomicimpactofpartialsightandblindnessintheUKadultpopulation,RNIB
3. WelshAssemblyGovernment(2012)NHSProgrammeBudgets2010/11.AccessedviaStatsWaleswebsite.
4. RNIBestimatebasedonpopulationdatafromtheOfficeforNationalStatisticsandtheindirectcostsofsightlossidentifiedinAccessEconomics,FutureSightLossUK1:TheeconomicimpactofpartialsightandblindnessintheUKadultpopulation(RNIB,2009)
5. RoyalCollegeofOphthalmologists(2007)CommissioningContemporaryAMDServices:Aguideforcommissionersandclinicians.London:RoyalCollegeofOphthalmologists.
6. NHS1000LivesPluscampaignnhs.uk/sites3/page.cfm?orgid=781&pid=48636
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8. Evans,JR,Fletcher,AE,Wormald,RP,‘Depressionandanxietyinvisuallyimpairedolderpeople’,Ophthalmology,114(2):283-288(2007)
9. Boyce,T(2011)Innovationandqualityinsightlossandblindnessservices:EyeClinicLiaisonOfficers.RNIB
10.AccessEconomics(2009)FutureSightLossUK1:TheeconomicimpactofpartialsightandblindnessintheUKadultpopulation,RNIB
11.RNIBestimatebasedondirectcostsintheNHSWalesProgrammebudgetfor2010/11,populationdatafromtheOfficeofNationalStatisticsandtheindirectcostsofsightlossidentifiedinAccessEconomics(2009)FutureSightLossUK1:TheeconomicimpactofpartialsightandblindnessintheUKadultpopulation,RNIB
12.RNIBCymruECLOServiceOpthalmologistQuestionnaire;CardiffandValeUniversityHealthBoard(2012)
13.Forexample:Mack,C(2008)EvaluationofECLOService(London,RNIB)andJohnston,A(2010)ECLOImpactReport:CostEffectiveandHighQualityCare:TheEvidenceforECLOs(London:RNIB)
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14.Scuffham,PA,Legood,R,Wilson,ECF,‘TheincidenceandcostofinjuriousfallsassociatedwithvisualimpairmentintheUK’,VisualImpairmentResearch4.1-14(2002)
15.ScuffhamP,ChaplinS,LegoodR(2003)IncidenceandcostsofunintentionalfallsinolderpeopleintheUnitedKingdom.JEpidemiolCommunityHealth,57:740–4.
16.StelVS,SmitJH,PluijmSM,LipsP(2004)Consequencesoffallinginoldermenandwomenandriskfactorsforhealthserviceuseandfunctionaldecline.A,geAgeing,33:58-65;McKayC,AndersonKE(2010)Howtomanagefallsincommunitydwellingolderadults:areviewoftheevidence.PostgradMedJ,86:299-306.
17.Lawrenceetal,Thecurrentcostsoftreatinghipfractures.Injury2005;36:88-91
18.Evans,JR,Smeeth,LFletcher,AE(2008)HospitaladmissionsinolderpeoplewithvisualimpairmentinBritain,BMCOphthalmology,8:16,1-5
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21.FriedliandParsonage,Promotingmentalhealthandpreventingmentalillness:theeconomiccaseforinvestmentinWales(2009)
22.Pey,T,Nezegwu,FandDooley,G,functionalityandtheneedsofBlindandPartiallySightedPeopleintheUK:Aninterimreport(2006)
23.Waernetal,‘Burdenofillnessandsuicideinelderlypeople:case-controlstudy’,BritishMedicalJournal,June2002,324:1355(2002)
24.Boyce,T(2011)Innovationandqualityinsightlossandblindnessservices:EyeClinicLiaisonOfficers.RNIB
25.RNIB,Unseen:Neglect,isolationandhouseholdpovertyamongstolderpeoplewithsightloss(2004)
26.Douglas,G,Corcoran,C,andPavey,S,Network1000:OpinionsandcircumstancesofvisuallyimpairedpeopleinGreatBritain(UniversityofBirmingham,2006)
©RNIBMay2013Registeredcharitynumber226227