The certification and registration process has come under scrutiny, prompting a call for changes. Olufunmi Majekodunmi reports.
Do health professionals really understand the importance of the certificate of visual Impairment (CVI)?
For a patient, certification can be a changing experience. What it should do is pave the way for better services and offer people the support they need to live their lives as independently as they can.
However, research by RNIB has uncovered that the certification and registration process is not a smooth journey for people with sight problems.
Investigating CVI
The report entitled The Certification and Registration Processes: Stages, barriers and delays, highlights that although certification is beneficial and the number of people with sight loss is increasing there has been a 'decline' in both certification and registration.
What the author notes is when the certification and registration (C&R) process goes to plan, patients can access support quickly.
However, when the process drags on the impact on the patient can be emotionally draining. Sadly, the C&R process appears to be in need of a serious makeover.
The report paints a picture of some professionals failing to grasp the implications of the process. Some ophthalmologists wrongly regard certification as an indication of "failure." Health professions were also unaware that the terms certification and registration did not mean the same thing,
The report offers a series of positive recommendations for health professionals, but unless followed through the process for many patients will remain an uphill battle.
Problems with the certification process
The process itself involves a number of health and social professionals ranging from hospital doctors, nurses, optometrists, eye clinic liaison officers ( ECLOs) and rehabilitation officers.
This, the report believes can make or break the process. It says all the stakeholders "have the "potential to create, barriers and delays or to improve the C&R process." The report asserts that a number of factors could be attributed to the falling numbers of CVIs and registrations issued.
The report believes that problems arise at failing:
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to certify at all or at the appropriate time at certification stage 1
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to complete the CVI and/or failing to send to Social Service Departments (SSDs) at certifications stages 2 and 3 and
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to register patients upon receipt of CVI at registration stage 1
Doctors under fire
In terms of certification, ophthalmologists were placed in the spotlight. They are cited as being uncertain on when to certify people with long term conditions such as glaucoma or diabetic retinopathy.
People with these conditions require long term support from low vision services and social services. But it says that ophthalmologists "found it difficult to ascertain when it is appropriate to certify these patients."
However, it concedes that not all cases are straightforward and making such a decision is not always clear cut. But it calls for more guidance in this area.
Author Dr Tammy Boyce spoke to a number of patients and professionals involved in C&R in three areas of England. Two consultants talked about the "pressure" to not certify patients. High rates of certification, in their eyes, equalled "failing" or not treating their patients adequately.
Understanding certification
The authors believe that audits illustrating certification levels at hospitals should be used to highlight that high certification rates do not mean poor service but provide support to their patients."
Health professionals also come under fire for not always understanding the implications of the process. A sentiment echoed by Simon Labbett, rehabilitation officer, visual impairment, Bradford Adult Social Services.
He says: "I suspect that a significant number of ophthalmologists have little idea of what services are available to their patients, and even less awareness that the CVI is a potential trigger for those services."
The report says that consultants regard certification as the end of the process. Patients do not see it this way. According to the report this is where patients start coming to terms with their sight loss. It adds: "The reality is that there may be little left to do medically but access to practical and emotional support can offer much more to change and improve a patient's quality of life."
It cites a small number of consultants who alarmingly did not see the point in certifying older people as they already received a television licence.
The report offers a series of recommendations aimed at all stakeholders and has been welcomed by the Association of Directors of Adult Social Services.
The way forward
Authors offered a number of suggestions for social service departments that includes, timeframes for the process, forging links between hospital eye services and low vision services at hospitals, maintaining a register of blind and partially sighted people and acquire a better understanding of the relationship between rehabilitation officers and hospital eye services.
John Nawrockyi, chair of the ADASS Disabilities Network says: "Councils may well wish to refer to these standards when reviewing their services for blind and partially sighted people."
However Labbett believes more needs to be done. "Until CVIs are screened in social services to a uniformly high standard by suitably qualified people, then registration is in danger of just being a paper exercise rather than gateway to services," he adds.
It calls for good practice at all stages of the process and a timeframe to complete all the stages. Philippa Simkiss, Head of Evidence and Service Impact at RNIB says this is crucial. "There are some guidelines from the Department of Health and these include timescales for contacts to be made with people at various stages in the processes. The problem is that these are not well known and the value of C&R to patients is not well recognised. One of the recommendations is to review the existing guidelines. RNIB would like to work with sector partners to do this," she says.
One thing everyone can agree on is that the status quo cannot remain. The sector cannot afford to do nothing. "If understanding of the benefits and processes of certification and registration are so poor how can we expect to give the best service to patients and people who need support. The Public Health Indicator gives us all an imperative to work together to improve the C&R processes. It is in all out interests to ensure that all those eligible are certified," adds Simkiss.
The recommendations include:
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Educate ophthalmologists of the importance of timely referral for rehabilitative support and certification and registration.
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There is a need for good practice guidelines for all stakeholders in the C&R processes. Guidelines should include length of time to complete each of the five C&R Stages. Patients should be made aware of these guidelines and the recommended length of time to complete each stage.
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Formal relationships between ophthalmology departments, low vision clinics and local social services should be established to improve understanding of the benefits of registration.
Related stories
Read what doctors think of the CVI process on NB's website.
More information
You can read RNIB's advice on certification and registration on its web pages.
Read a patient's experience of obtaining a CVI on NB's web pages.
Have your say on what needs to be done to revamp the C&R process email the editor at: nbmagazine@rnib.org.uk
Article originally published in NB magazine December 2012.