Vision rehabilitation services: Investigating the impacts of two service models

Introduction

The Care Act 2014 highlighted the importance of rehabilitation by requiring local authorities to promote well-being and independence before people reach a crisis point. The Act explicitly
referred to the importance of rehabilitation for people with sight loss. While demographic changes mean an increasing number of people live with sight loss, research evidence about how
much rehabilitation services improve outcomes for this group, what are best models of service delivery, and whether they are good value for money is limited.

Objectives

This project sought to narrow this evidence gap by exploring the (cost-) effectiveness of two models of vision rehabilitation (VR) services (Local Authority in-house and contracted-out) in England.

Methods

The study employed a comparative design and mixed methods approach. A selection of people with sight loss using eighteen VR services (nine in-house and nine contracted-out) were
interviewed by telephone at the start of using the service (baseline), four weeks (T1) and eight weeks (T2) after they started using the service, and six months later (T3). Differences in experiences and outcomes were examined between the two groups over time. 233 service users were recruited to the study and 73% completed follow-up at the final T3 interviews.

At each interview, three standardised and one bespoke measures were used to assess:

• Health-related quality of life (EQ-5D-5L)
• Vision specific quality of life (NEI-VFQ-25) • Social care-related quality of life (ASCOT SCT-4)
• Use of services – including NHS, social care, third sector and independent providers, as well as out-of-pocket and informal care costs (SCPQ).

Additionally, semi-structured qualitative interviews were conducted in nine VR services (five in-house and four contracted-out services) with one manager, one rehabilitation officer and
two service users interviewed from each of those services.

Findings

• Users of both in-house and contracted-out services reported similar positive feelings regarding the impact of rehabilitation, although younger people (aged 65 and under)
  reported greater gains.
• None of the services used a validated tool to measure and monitor individual outcomes.
• On average, vision- and social care-related quality of life and level of independence all marginally improved between baseline and six months, but there were no differences between service types.
• There were differences in delivery of the two models. In-house services had longer planned VR duration but longer waiting times; users were referred to VR for more varied reasons; and rehabilitation goals were more likely to include additional areas of support.
• In-house VR services were likely to be the more cost-effective from a social care perspective. Contracted-out VR services were likely to be the more cost-effective from an integrated social and health care perspective, whether outcomes were measured in SC-QALYs or H-QALYs.

Resources

Journal paper

Longo F, Saramago P, Weatherly H, Rabiee P, Birks Y, Keding A, Sbizzera I (2020) Cost-effectiveness of in-house versus contracted-out vision rehabilitation services in England, Journal of Long-Term Care, 2020, 118–130.