Department of Health launches the updated Certificate of Vision Impairment Form and Explanatory Notes. With Key messages for different audiences

17 August 2017
Source: Department of Health

Background

When a person’s sight loss reaches certain levels they are entitled, if consenting, to be certified as severely sight impaired or sight impaired by a Consultant Ophthalmologist. Certification should be seen as an opportunity for the patient to access support and services and not an end point. Certification of Visual Impairment became an NHS outcome measure/public health indicator for England in 2012.

From 17 August 2017, a new CVI form and accompanying Explanatory Notes for Ophthalmologists will replace those currently found on DH website. These are to be adopted immediately with existing stock destroyed.

The updated the CVI and revised the Explanatory Notes for consultant ophthalmologists and hospital eye clinic staff in England.

They are available at:

https://www.gov.uk/government/publications/guidance-published-on-registering-a-vision-impairment-as-a-disability

The purpose of updating the CVI form

The aim is to make the CVI process more effective to ensure that people who are newly certified as sight impaired or severely sight impaired receive the support they need as soon as possible.

The Royal College of Ophthalmologists together with RNIB highlighted that the Certificate of Vision Impairment form (CVI) required urgent updating as important information for patients such as the RNIB Helpline, Drivers Medical Branch of the DVLA are incorrect, preferred format options are outdated (e.g. tape and computer disk) and references to legislation are also outdated (e.g. the Equality Act has replaced the Disability Discrimination Act). It was also an opportune time to simplify the form and ensure that it captures the information to support people to receive appropriate help. A sub-group of The Royal College of Ophthalmologists Professional Standards Committee was established to update the CVI form, raise awareness amongst Ophthalmologists and improve patient information and experience.

As a consequence of this, the updated CVI form will:

 

  • ensure all information is current and accurate
  • be simplified and collect only essential information
  • be easier and quicker for Ophthalmologists and Eye Clinic staff to complete
  • be one CVI form for all patients (adults and children)
  • provide better information to patients about sources of support

It is important that the updated CVI form and Explanatory Notes are embedded into hospital eye services, local authorities and the voluntary sector to ensure it is successful in achieving these objectives

The aims of certification:

  1. To let the person’s resident local authority know about their circumstances so that they can make contact to identify any help the person might need with day-to-day tasks.
  2. To act as a mechanism of referral to the person’s resident local authority so that, if they consent, they can be registered with their local authority as sight impaired (partially sighted) or severely sight impaired (blind).
  3. To provide epidemiological information about the causes of sight loss to helps the NHS to identify any trends in certain eye conditions and help with planning services.
  4. To act as a gateway to enable the person to access information and support.

 

Key Information

Over 20,000 people each year are certified as sight impaired or severely sight impaired. There are over 360,000 people in England, including 47,000 veterans, who are sight impaired or severely sight impaired and these numbers are set to increase.

There are around 25,000 children and young people aged 0-16 whose sight loss is of sufficient severity to affect their education and learning. Sight loss presents different challenges for children, and severe vision impairment has a major impact on development and the acquisition of fundamental skills. Specialist support is vital to minimise the risk of adverse outcomes and promote successful transition to adulthood.

Eye Clinic Liaison Officers (ECLOs)/Sight Loss Advisors, local authorities, and specialist voluntary organisations can help people living with sight loss, and the sooner they intervene the better to promote independence and support people to remain in their own homes and local communities for as long as possible.

Where to get further information, advice and support

“Sight Loss: What we needed to know”, written by people with sight loss, contains lots of useful information including a list of other charities who may be able to help you. Visit http://www.rnib.org.uk/sightlossinfo

‘Sightline’ is an online directory of people, services and organisations that help people with sight loss in your area. Visit http://www.sightlinedirectory.org.uk

‘Starting Point’ signposts families to resources and professionals that can help with the first steps following your child’s diagnosis.

Visit http://www.vision2020uk.org.uk/devs/upg3/startingpoint

Your local sight loss charity has lots of information, advice and practical solutions that can help you. Visit http://www.visionary.org.uk

RNIB offers practical and emotional support for everyone affected by sight loss. Call the Helpline on 0303 123 9999 or visit http://www.rnib.org.uk

Guide Dogs provides a range of support services to people of all ages. Call 0800 953 0113 (adults) or 0800 781 1444 (parents of children/young people) or visit http://www.guidedogs.org.uk

Blind Veterans UK provides services and support to vision impaired veterans. Call 0800 389 7979 or visit http://www.noonealone.org.uk

Key messages from the Department of Health

The most important function of the CVI is to ensure that those diagnosed with permanent vision loss are put in contact with sources of help.

The Department of Health has worked in partnership to revise the Explanatory Notes and update the CVI form, working closely with The Royal College of Ophthalmologists, RNIB and others.

Others who assisted included the Certifications Office, Moorfields Eye Hospital, Association of Directors of Adult Social Services, NHS England, Her Majesty’s Revenue and Customs, Department for Work and Pensions, Department for Health and Social Services Welsh Government, Health and Social Care Board Northern Ireland and the Scottish Government.

In discussion with stakeholders, certification is proposed based on visual acuity, visual field and clinical judgement. This means that the Consultant would still be able to use their own professional judgement to certify people as now.

A ‘work’ test based on previous legislation has been removed from the Explanatory Notes as it no longer reflects current clinical opinion. This has also been changed in Northern Ireland and Wales. The current version of the Explanatory Notes makes reference to the National Assistance Act 1948 (NAA), which has largely been superseded by the Care Act 2014 in England and which was the previous basis for the maintenance of registers of blind and other persons by local authorities. The NAA defined “blind person” as a person so blind as to be unable to perform any work for which eyesight is essential.

 

Key Messages by audience

Key messages for patients

Objectives: To inform people about the benefits of certification and registration and the new and improved CVI form.

The most important function of the CVI is to ensure that those diagnosed with permanent vision loss are put in contact with sources of help.

A CVI form is given to a patient who has been assessed by an Ophthalmologist as severely sight impaired (blind) or sight impaired (partially sighted). With a patient’s consent, the form is then passed on to their GP, local council and The Royal College of Ophthalmologists Certifications Office.

Councils use this form to ensure it meets the needs of all severely sight impaired and sight impaired people in its community. Councils have duty keep a register of people who are partially sighted and blind.

The Government is producing a new Certificate of Vision Impairment (CVI) commencing 17 August 2017. The updated CVI form will provide councils with better information about your circumstances and refer you to specialists that can help you.

The advantages of benefits and registration:

  • Registration is often a positive step to help you to be as independent as possible.
  • Your local council can contact you to find out what support and advice you might need. This may include vision rehabilitation for adults or habitation for children and young people.
  • You may be entitled to a wide range of concessions including discounts on travel, TV licence and benefits.
  • If you are registered, you may find it easier to prove the degree of your sight loss and eligibility for benefits.
  • The information of the form will be used to examine the causes of sight loss and help the NHS identify any trends in certain eye conditions and help with planning services.

Key messages to Ophthalmologists

Objectives: To inform Ophthalmologists of the new and improved CVI form and to encourage completion where certification is appropriate.

The most important function of the CVI is to ensure that those diagnosed with permanent vision loss are put in contact with sources of help.

Ophthalmologists ensure that patients receive the optimum treatment plan suitable for their eye conditions. Patients who have reached certain levels of sight impairment, are entitled to receive further support from their local authority.  This is facilitated by ophthalmologists who can certify them as severely sight impaired or sight impaired using the Certificate of Vision Impairment (CVI).

The Royal College of Ophthalmologists (RCOphth) has worked with the Department of Health, RNIB and other charities and organisations in the eye health sector to develop a new CVI form, which makes the certification process much easier for both the ophthalmologist and the patient.

The form has been improved and simplified making it easier for Ophthalmologists and Eye Clinic staff to complete, is now more relevant to both adults and children and provides information to patients regarding support that is available to them.

Also, the newly revised Explanatory Notes provide more clarity for regarding certification and diagnosis.

It is important to note that the patient can now consent separately to either or both the collection of their information for certification and for epidemiological research.

Members are asked to complete the updated CVI form as fully as possible, as this means the information will assist local authorities in making contact with the patient who has been certified with sight loss.

It is important that all the stocks of old CVI forms are destroyed on receipt of receiving the new stocks.

Don’t forget that if you have an Eye Clinic Liaison Officer (ECLO)/Sight Loss Advisor or volunteer service in the hospital eye service, they can be of assistance to ophthalmology staff/teams in processing the forms, and explaining the process of both certification and registration to patients and families.

 

Key messages for sight loss professionals, eye clinic staff, for example ECLOs and volunteers, providing support in eye clinic departments

 

Objectives: To inform professionals about the new and improved CVI form which replaces the current version, and the benefits of certification and registration.

The most important function of the CVI is to ensure that those diagnosed with permanent vision loss are put in contact with sources of help.

The new CVI form is available from 17 August 2017 and will replace the current form. Eye health professionals and eye clinic staff play a key part in processing the forms and it is important that they all continue to do so.

Benefits of the new form:

 

  • The new CVI form has been simplified making it easier to complete.
  • Eye clinic staff have a key role in processing the updated forms, and ensuring they are embedded in eye clinics and stocks of old forms are destroyed.
  • Eye clinic staff have a key role in supporting the smooth completion and processing of CVI forms in eye departments and linking with local authorities.
  • It covers both adults and children and contains more information for patients regarding support that is available to them.
  • It provides epidemiological information about the causes of sight loss to help the NHS to identify any trends in certain eye conditions and help with planning services.
  • Revised and useful explanatory notes aimed at providing more clarity surrounding certification and diagnosis.
  • Professionals are encouraged to talk to patients about the forms and the benefits of the certification and registration process.
  • Professionals should ensure all the information is fully completed as this will be used by local authorities when they first make contact with the newly-certified person.
  • Eye clinic staff have a key role in ensuring that babies, children and young people are referred promptly to the local authority’s specialist vision impairment education service. A referral should be triggered by a ‘No’ or ‘Not Known’ response to the question in Part 3 of the CVI form asking if a child/young person is known to the service.

 

Key messages for local authorities

Objectives: To inform local authorities about the new and improved CVI form which replaces the current version, and the benefits of certification and registration.

The most important function of the CVI is to ensure that those diagnosed with permanent vision loss are put in contact with sources of help.

The Association of Directors of Adult Social Services support the updated CVI form and revised Explanatory Notes and encourage all local authorities to work closely with eye clinics to ensure the new forms are used and fully completed in their area.

The updated CVI form is now more relevant to both adults and children and provides more information to people who have been certified as sight impaired or severely sight impaired regarding support that is available to them.

The Association of Directors of Adult Services, through the Physical and Sensory Impairment Network, has been involved in the production of the updated CVI form and consider that this will assist local authorities in making contact with people referred to them following the completion of a CVI and will support local authorities in discharging their responsibilities under the Care Act.

The Association of Directors of Adult Social Services reminds local authorities of the Care and Support Statutory Guidance which states that “upon receipt of the CVI the local authority should make contact with the person issued with the CVI (regardless of whether the person has decided to register or not) within 2 weeks to arrange their inclusion on the local authority’s register (with the person’s informed consent) and offer individuals a registration card as identified on the CVI registration form. Where there is an appearance of need for care and support, local authorities must arrange an assessment of their needs in a timely manner” (Care and Support Statutory Guidance para. 22.16).

Local Authorities can use sight registers to ensure information about wider services is made accessible to people provided consent has been given to do so, such as assisting them to vote in elections.

The Association of Directors of Children’s Services reminds local authorities that for children, education plays the key role in specialist support and the lead professional is usually the local authority specialist teacher for children and young people with vision impairment. Because of the developmental vulnerabilities associated with childhood vision impairment, early referral direct to the vision impairment service is essential.

The Children and Families Act 2014 and Special Educational Needs and Disability (SEND) Code of Practice 2015 highlight the importance of early intervention and provision of support from specialist services as quickly as possible. Another key professional is the habilitation specialist, who teaches children and young people with vision impairment to move around more independently and do practical everyday tasks for themselves. All children and young people with vision impairment should receive an assessment of their mobility and independence needs.

Key messages for GPs

Objectives: To inform GPs about the new and improved CVI form and to remind them of the RCGP guidance on supporting (particularly older) patients with sight loss.

A copy of the CVI is sent to the patient’s GP, primarily for information rather than for specific action. It provides GP’s with very useful information regarding a patient with significant visual impairment and should help GPs in their holistic management of their patients.

GPs should be reminded that the most important function of the CVI is to ensure that those diagnosed with permanent vision loss are put in contact with social services and other sources of help and so they could check next time they see the patient that any support they need has been put into place.

For three years, the Royal College of General Practitioners had a major focus on eye health and sight loss amongst their older patients as a clinical priority. Several resources produced during that time including an essential guide to low vision which is still available on the RCGP website. This revision of the CVI is a great opportunity to remind GPs of these resources.

Sight loss in older people: The essential guide for general practice is available at

http://www.rcgp.org.uk/~/media/Files/CIRC/Eye%20Health/RCGP-Sight-Loss-in-Older-People-A-Guide-for-GPs.ashx

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