Vision rehabilitation services
Consistent outcome measures would benefit divergent landscape of vision rehabilitation services, study finds
More standardised measurement of outcomes would make assessing council-run and contracted-out models’ relative benefits for service users and commissioners much more straightforward, research suggests
Rehabilitation services for people with visual impairments seem to vary between council-run areas and those where they are contracted out, with a lack of standardised outcome measurements making evaluation difficult, research has found.
A study by researchers at the University of York found qualitative differences in the type of support available to service users between local authorities that had kept services in-house and those that have commissioned charities to run them.
Council-operated services tended to operate as part of sensory impairment services, and to take a broader approach that engaged with people for longer.
Meanwhile rehabilitation run by third parties was likely to take a narrower focus, centred on mobility and independence, but also to offer benefits – such as group work – that local authorities rarely provided.
But the researchers found the lack of any common tool through which individual outcomes are gauged presented a major obstacle to authoritatively assessing which models work best. Staff and managers working across different vision rehabilitation services acknowledged that systems were not adequate to capture accurately their benefits to individuals.
“We found in-house and contracted-out services are doing slightly different things,” said Professor Yvonne Birks, one of the study authors. “But there seems to be very little consistent outcome measurement, which makes evaluating the systems’ relative merits challenging.”
Professor Birks added that difficulties in collecting data from often older and isolated people with sight loss, using standardised questionnaires over the telephone presented challenges, resulting in only 50% of the proposed 500 sample being recruited. This meant the study’s conclusions were less robust than they might otherwise have been – further bolstering the case for commissioning authorities to consider routinely collecting comparable information about their services.
The study, which used both qualitative and quantitative methods, set out to explore both overall effectiveness and value for money of in-house and contracted-out vision rehabilitation services.
The Care Act 2014 requires local authorities to promote wellbeing and independence before people reach crisis point – and makes specific reference to people with sight loss. Yet there has been limited research into how well vision rehabilitation works, in terms of improving outcomes, and which models are most cost-effective.
The two types of services tended to set slightly different goals with their clients at the outset. Council-run departments were more likely to include targets around employment advice and emotional support, while contracted-out operations prioritised information provision and signposting.
Six months on from becoming involved with services, some limited improvements were observed in terms of study participants’ quality of life, both on vision-related and social care-related measures.
“After receiving [services], most [people] reported improved confidence and motivation, and a greater sense of independence,” the study findings report said. “People commonly reported a sense of security in knowing support was there if needed.”
But there were no statistically significant differences in quality of life gains between the two approaches to service delivery. Service users gave similar reports around key elements such as frequency of visits, supply of equipment and support around independent living – and their overall level of contentment with the services.
Service users did however report other differences in their experiences, with those involved with in-house operations reporting more generic one-on-one support such as around benefits, form-filling and arranging home adaptations.
Those accessing contracted-out services were more likely to be signposted in the direction of broader support, but commented that being able to participate in social group activities had widened their networks and reduced feelings of isolation.
Rehabilitation officers working for local authorities spoke favourably to researchers about being able to work flexibly and holistically but said staff shortages and competing demands within hard-pressed teams had inevitable impacts on waiting times.
Their counterparts in third-party organisations noted the benefits of being able to focus on vision rehabilitation work, with other social care-related issues being referred to social services and group activities being supported by volunteers. They also commented on the negative effects of local authority budget pressures on staff resourcing.
Which model delivered best value depended on the viewpoint taken, the study found. A social care-only perspective was much more likely to show that in-house services offered best value for money, whereas an integrated health and social care perspective tended to favour the contracted-out model.
“Taken at face value, these study findings suggest that policymakers working in contexts without integration between social and health care sectors may make different decisions to policy makers operating in contexts with greater integration,” the report noted.
Looking to the future, local authority commissioners and organisations delivering services would both benefit from standardising the collection of outcomes data, Professor Birks said.
“Commissioners could see if what they offered in-house was more effective than what was offered elsewhere, while external services would be able to make a better case as to why commissioners should use them,” she said. “This information would really benefit everybody.”
Full summary findings
NIHR SSCR (2020) Vision Rehabilitation (VR) Services: Investigating the Impacts of Two Service Models, Research Findings 079, NIHR School for Social Care Research, London.
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.
This study was funded by the NIHR School for Social Care Research and led by the Social Policy Research Unit at the University of York.
The findings were completed before COVID-19 and have been published to support NIHR SSCR’s requirement that findings from all completed studies are made publicly available.