RNIB Branded Word Template

Sight Loss Data Tool Version 3.4: Guidance Notes

April 2017 Version 1.0 2

Contents

Sight Loss Data Tool Version 3.4: Guidance Notes 1 Contents 2 1. Introduction 6 1.1 Guidance notes structure...... 6 1.2 Modelled estimates...... 7 1.3 Feedback...... 8 1.4 Sight Loss UK and Evidence-based reviews...... 8 1.5 Further information...... 9 2. Geography 10 3. Area profile 11 3.1 General population – number and proportion by age...... 11 3.2 General population – number and proportion by ethnic group ...... 12 3.3 Local area deprivation...... 13 3.4 Rural/urban classification...... 15 3.5 General health and health problem or disability...... 16 3.6 Unpaid carers...... 18 3.7 Carers and social contact...... 18 3.8 Smoking prevalence...... 19 3.9 Excessive weight prevalence...... 20 4. Living with sight loss22 4.1 Number of people living with sight loss...... 22 4.2 Prevalence of sight loss...... 24 4.3 Future projections of the number of people living with sight loss and the prevalence of sight loss in 2020, 2025 and 2030..26 5. Certification 27 5.1 Number of Certifications of Vision Impairment...... 27 5.2 Rate of Certifications of Vision Impairment by specific eye conditions...... 28 5.3 Change in rate of Certifications of Vision Impairment from 2012/13 to 2013/14...... 29

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6. Registration 31 6.1 Number of people registered as blind or partially sighted...31 6.2 Proportion of people registered blind or partially sighted also recorded as having an additional disability...... 33 6.3 Rate of registration per 100,000 people...... 34 6.4 Percentage change in registration over time...... 35 7. Children and young people 37 7.1 Number and proportion of children and young people...... 37 7.2 Number of blind and partially sighted children and young people (including the number with an additional disability)...... 38 7.3 Number and proportion of children with visual impairment as primary SEN...... 39 7.4 Local Offer for children and young people sensory service.41 8. Working age 43 8.1 Estimated number of people of working age living with sight loss...... 43 8.2 Number of people of working age registered as blind or partially sighted...... 44 8.3 Unemployment rate of people aged 16-64...... 45 8.4 Proportion of population that drive to work...... 46 8.5 Gap in the employment rate between those with a long-term health condition and the overall employment rate...... 47 9. Older people 49 9.1 Number of older people...... 49 9.2 Number of older people living with sight loss...... 50 9.3 Number of older people living in care homes...... 51 9.4 Number of older people registered as blind or partially sighted...... 52 9.5 Estimated number of older people living with sight loss...... 53 10. NHS sight tests 55 10.1 Number of NHS sight tests...... 55 10.2 Rate of NHS sight tests...... 57 11. Cost of sight loss 59

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11.1 Total and proportion of NHS expenditure on problems of vision or ophthalmic services...... 59 11.2 NHS expenditure on problems of vision per person...... 62 11.3 Total indirect cost of sight loss...... 63 11.4 Indirect cost of sight loss per person...... 64 12. Sight threatening eye conditions 66 12.1 Number of people living with age-related macular degeneration; 2015, 2020, 2025 and 2030...... 66 12.2 Number of people living with cataract in 2015, 2020, 2025 and 2030...... 69 12.3 Number of people living with glaucoma in 2015, 2020, 2025 and 2030...... 70 12.4 Number of people living with diabetes in 2015, 2020, 2025 and 2030...... 72 12.5 Proportion of patients who were invited to, and attended, a retinal screening appointment...... 74 12.6 Number of people living with diabetic retinopathy and severe diabetic retinopathy in 2015, 2020, 2025 and 2030...... 75 13. Support 78 13.1 Ophthalmology outpatient appointments...... 78 13.2 Ophthalmology waiting times from referral to treatment....80 13.3 Number of Trusts with eye clinic support in England / Access to eye clinic support Scotland, Wales and Northern Ireland...... 81 13.4 Rehabilitation support – visual impairment...... 83 13.5 Number and proportion of blind and partially sighted people in receipt of Disability Living Allowance...... 85 13.6 Number of blind and partially sighted people in receipt of adult social care services...... 86 13.7 Proportion of adult social care users who do not have as much social contact as they would like...... 87 13.8 Number of blue badges issued and held by people registered blind...... 88 14. Falls and other health conditions and disabilities 90 14.1 Falls...... 90

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14.2 Dementia and sight loss...... 92 14.3 Stroke...... 94 14.4 Hearing impairment...... 96 14.5 Dual sensory loss...... 98 14.6 Number of people registered with dual sensory loss...... 102 14.7 Number of adults with a learning disability and visual impairment...... 103 15. Benchmarking Indicators 106 15.1 People aged 75+ (rate per 1,000)...... 107 15.2 People from BME groups (rate per 1,000)...... 109 15.3 Living with sight loss – 2015 (rate per 1,000)...... 110 15.4 Living with sight loss – 2030 (rate per 1,000)...... 112 15.5 Certifications of Vision Impairment 2013/14 (rate per 100,000)...... 114 15.6 Blind and partially sighted register (rate per 100,000).....115 Appendix A – Additional resources 118 1. Toolkits and guides for using data...... 118 2. Directory of services...... 119 3. Other useful data tools...... 119 Appendix B – Geographical Areas 124 1. England Regions...... 124 2. Scotland Regions...... 126 3. Wales Regions...... 126 4. Northern Ireland Regions...... 127 5. NHS Area Team and NHS Trust (England)...... 127 6. Clinical Commissioning Group (England)...... 137 7. NHS Health Board (Wales and Scotland)...... 140 8. NHS Health and Social Care Trust (Northern Ireland)...... 142 9. Hospitals (Northern Ireland)...... 143

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1. Introduction RNIB’s Sight Loss Data Tool provides information about blind and partially sighted people and those at risk of sight loss at a local level throughout the UK.

The data tool is aimed at supporting expert local knowledge by providing up to date statistics on a wide range of different indicators. These indicators are broadly based either on official statistics (for example, Office of National Statistics [ONS] population projections for 2016, register of blind and partially sighted people) or modelled estimates based on existing research (for example, the number of people living with sight loss).

These indicators can support a number of different activities, including:  Improving your understanding of blind and partially sighted people and those at risk of sight loss in your area.  Accessing local, relevant, evidence based statistics to engage with funders or commissions.  Accessing population data to use in planning services or strategy development.

You can find the Sight Loss Data Tool along with ‘How to use the data tool’, a user guide, which can help you make the most of the features in the tool, at www.rnib.org.uk/datatool.

1.1 Guidance notes structure These guidance notes have been developed to accompany the Sight Loss Data Tool. This document provides further details of the sources of data and evidence, calculations that have been used to develop the indicators, how to interpret the data and limitations that may need to be considered when interpreting the data.

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The structure of this document follows the chapters used in the full report generated in the data tool. Information on benchmarking indicators has been included in the last data section followed by two appendices.

Indicators have been grouped together where they share sources and methodology. There is a brief introduction to each group of indicators and the following information:

Coverage and type The coverage of an indicator relates to the parts of the UK which are covered by the data. This is particularly relevant for official statistics as coverage and availability often varies between the countries within the UK.

The type of indicator highlights whether or not the data is based on official statistics or is an estimate calculated by RNIB.

Sources References for each indicator are provided. Users can refer back to the sources for more in depth information or analysis where required.

Definitions Information related to how the data was collected, what it includes and any information about terminology. The guidance notes may refer to ‘raw data’ worksheets in the Sight Loss Data Tool. These hold all data items for all indicators in the automated reports.

Calculation Details of any calculations used in developing the indicators are highlighted.

1.2 Modelled estimates

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Some of the indicators in the data tool are estimates based on existing research and evidence. These estimates are often the only way that we can provide information on certain topics, and they have been included as a guide for further discussion. They do not take into account local variation or additional demographic factors that are not included in the base prevalence rates. If you have any questions about using this type of data then please contact us at [email protected].

1.3 Feedback Your feedback is extremely important to RNIB. Prioritisation of the development of features included in Version 3.4 of this data tool was based on the feedback we received for Version 2. If different geographical boundaries would be helpful, or if information you would like to see included is missing then please let us know.

We would also like to hear about the aspects of the data tool you find most useful, how you are using it and of any impact having access to this data has had on the support blind and partially sighted people and those at risk of sight loss receive in your area. Please contact us at [email protected].

1.4 Sight Loss UK and Evidence-based reviews Sight Loss UK is an evidence review report produced by RNIB. It presents a range of indicators that show us what life is like for people with experience of sight loss and for those at risk of sight loss at a national level.

Our Evidence-based reviews present an in depth look at the experiences of blind and partially sighted people by age group (i.e. children and young people, working age people and older age people). The reviews present a profile of the specific group, the policies that govern and impact upon their lives, and a commentary on what the evidence tells us.

You can access “Sight Loss UK 2013” and the Evidence-based reviews at www.rnib.org.uk/research.

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1.5 Further information If you have any questions about the Sight Loss Data Tool or require any additional statistics or evidence related to blind and partially sighted people or those at risk of sight loss, then please contact [email protected].

The best way to keep up to date with RNIB’s research, including future updates to the Sight Loss Data Tool, is to sign up for email notifications on the RNIB website. You can sign up for notifications by sending your email address or contact details to www.rnib.org.uk/research.

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2. Geography The aim of the Sight Loss Data Tool is to provide information at a local level throughout the UK. Below is a brief summary of the geographical boundaries used in the data tool, a complete list can be found in Appendix C.

England Data in England is provided for upper-tier council areas, that is Unitary Authority and County level, and also for lower-tier council areas including District Councils and Boroughs. Data is also provided for the nine government office regions in England. Some health data is provided by NHS Area Team and local NHS Trust. Official healthcare expenditure data is provided by Clinical Commissioning Group.

If you require further information based on English health boundaries, further information and links can be found in section 1 of Appendix A.

Wales Data in Wales is provided for all local authorities, regions based on NUTS classifications and some health data is provided for regional Health Boards. For more information, see Appendix B.

Scotland Data in Scotland is provided for all local authorities, regions based on NUTS classifications and some health data is provided for regional NHS Health Boards. For more information, see Appendix B.

Northern Ireland Data in Northern Ireland is provided for all local government districts, regions based on NUTS classifications and some health data is provided for NHS Health and Social Care Trusts. For more information, see Appendix B.

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3. Area profile This section provides information about the characteristics of a local area. This includes the age and ethnicity of the residents of the area and information about the average level of deprivation.

3.1 General population – number and proportion by age These indicators provide an overview of the age profile of the general population. Data is provided on specific age bands covering both number and proportion of the area population in each age band.

Coverage and type All areas; official statistics.

Sources ONS (2016), 2015 mid-year detailed population estimates, Office for National Statistics.

Definitions ONS population estimates refer to the usually resident population on 30th June of the reference year and are published annually. They are derived by taking the population measured in the most recent census; ageing this on; then adjusting for births, deaths, international migration and internal migration (that is, migration within the UK).

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The age bands used in the data tool are:  0–4 years  5–17 years  18–29 years  30–49 years  50–64 years  65–74 years  75–84 years  85 years and over

Calculation The proportion of people in each age band was calculated as follows: Proportion in age band = (Number in age band/Total number of people)

3.2 General population – number and proportion by ethnic group These indicators provide an overview of the population by ethnic group. Data is provided for both the number and proportion of the area population in each ethnic group.

Sources ONS (2012), 2011 Census: Key Statistics for local authorities in England and Wales, Ethnic group. Office for National Statistics.

NRS (2013), 2011 Census: Ethnic groups. National Records of Scotland.

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NISRA (2013), 2011 Census: Ethnicity, Identity, Language and Religion. Northern Ireland Statistics and Research Agency.

Definitions Ethnic group classifies people according to their own perceived ethnic group and cultural background in response to the 2011 Census.

The following broad categories have been used in the data tool, taken from the 2011 Census:  White (this includes British, Irish and Other White)  Mixed Ethnicity (this includes White and Black Caribbean; White and Black African; White and Asian; and Other Mixed)  Asian or Asian British (this includes Indian; Pakistani; Bangladeshi; and Other Asian or Asian British)  Black or Black British (this includes Black Caribbean; Black African; and Other Black or Black British)  Chinese or Other Ethnic Group

Calculation The proportion of people in each ethnic group was calculated as follows: Proportion in ethnic group = (Number in ethnic group/Total number of people)

3.3 Local area deprivation These indicators provide information on the extent of deprivation in a local area. For some areas, there is also information on how the local authority ranks in terms of overall deprivation when compared to others in the same country.

Coverage and type Extent of deprivation is available for all areas, rank of local authority is available for England and Northern Ireland; official statistics.

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Sources DCLG (2015), English Indices of Deprivation 2015: county summaries. Department for Communities and Local Government.

Welsh Government (2014), Revised 2015, Welsh Index of Multiple Deprivation 2014. Welsh Government.

Scottish Government (2012), Scottish Index of Multiple Deprivation. Scottish Government.

NISRA (2010), Northern Ireland Multiple Deprivation Measure 2010. Northern Ireland Statistics and Research Agency.

Definitions The extent of deprivation is a measure of the proportion of people in a local authority who are living in the most deprived Lower Layer Super Output Areas (LSOAs) in the country (note: LSOAs are called Data Zones in Scotland). LSOAs were developed to improve the reporting of small area statistics, with the unit of geography having between 1,000–3,000 people or 400–1,200 households within its boundary.

Official statistics on deprivation in all countries provide an overall rank for local authorities (in England both rank for upper-tier authorities and lower-tier authorities is provided). This was calculated by using the average for all LSOAs in a council area across all indices of deprivation.

For Wales, the percentage of LSOAs in the most deprived 20 per cent of all Welsh areas is also provided in the raw data (worksheet 4). For Scotland, the percentage of data zones in the most deprived 15 per cent of all Scottish areas is also provided in the raw data (worksheet 4).

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Full details of the definitions used in each country and the weightings used to calculate the extent of deprivation can be found in the original sources.

Calculation None.

3.4 Rural/urban classification The official rural-urban classifications have been produced to indicate whether an area is rural, urban or a mixture. The level of rurality can give an indication of the challenges faced by blind and partially sighted people in accessing services, employment, etc.

Sources ONS (2011), England and Wales rural/urban classification - Local authority districts, Office for National Statistics.

NRS (2010), Percentage Population Estimates by Urban Rural Classification, mid-2010, National Records of Scotland.

RUNIHE (2009), Northern Ireland: Urban Rural Composition (administrative geographies), Research Unit Northern Ireland Housing Executive.

Definitions

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For England and Wales, the 2011 rural-urban classification (RUC, 2011) gives a consistent measure of rural/urban areas across the countries. A suite of classifications has been produced for use at a variety of geographic levels. The classification of local authorities contains six classes. However, in the data tool only the proportion of rural versus urban areas within the authority is listed. For more details, see the user guide on the Office for National Statistics website at www.ons.gov.uk.

For Northern Ireland, the latest rural-urban classification available was published in 2009, and includes the proportion of rural versus urban areas within the authority in the same format as the England and Wales data. For more information visit the Northern Ireland Statistics and Research Agency website at www.nisra.gov.uk.

The Scottish Government Urban Rural Classification provides a standard definition of rural areas in Scotland published in 2010. The indicator includes the percentage of an area classified as 'urban' or 'accessible small town' versus the percentage of an area classified as ‘rural’ or ‘remote small town’. For more information, visit the Scottish Government website at www.gov.scot.

Calculation None.

3.5 General health and health problem or disability The 2011 Census asked questions about self reported general health and life-limiting health conditions/disabilities. The data has been published at local authority level for all countries in the UK. This information can give a general indication of health inequalities across the country.

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Sources 2011 Census (2013), Long-term health problem or disability, England and Wales. Office for National Statistics.

2011 Census (2013), General Health, England and Wales. Office for National Statistics.

Scottish Government (2012), Scotland’s Census 2011: Detailed characteristics on Health in Scotland. Scottish Government.

NISRA (2013), Long-Term Health Problem or Disability and General Health tables. Northern Ireland Statistics and Research Agency.

Definitions One specific question in the 2011 Census asked about self- assessed general health. Each person in the household was asked to rate their health in general; the possible responses were ‘Very good’, ‘Good’, ‘Fair’, ‘Bad’ and ‘Very bad’. The data recorded show the proportion of responses where people answered ‘Bad’ and ‘Very bad’.

Self-reports are useful in indicating general well-being, health- related quality of life, the experience of long-term illness and the relative risks of future admission to hospital, impairment and mortality.

Another question asked about health problems and disabilities. Each person in the household was asked whether they had a long- term health problem or disability, which limits activities in any way, for a period of one year or longer, including problems which were due to old age. There were three answer options – ‘Yes, limited a lot’, ‘Yes, limited a little’ and ‘No’. The data recorded shows the proportion of responses where people answered that their activities were limited to any level. This gives a self-reported indication of the prevalence of disability around the country.

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Calculation None.

3.6 Unpaid carers The provision of unpaid care in England and Wales is becoming increasingly common as the population ages, with an expectation that the demand for care provided by spouses and adult children will increase further in coming years. Unpaid care from relatives saves money for national budgets but has adverse impacts on the lives of those providing care.

Sources ONS (2013), 2011 Census: Provision of unpaid care England and Wales. Office for National Statistics.

Scotland's Census (2011), Provision of Unpaid Care, Scotland.

NISRA (2015), Census 2011: Provision of Unpaid Care, Northern Ireland Statistics and Research Agency.

Definitions A question was included in the 2011 Census asking each person in the household whether they were a provider of unpaid care to a relative. Four different answer options were included; ‘No care’, ‘1- 19 hours a week’, ‘20-49 hours a week’ and ‘50 or more hours a week’. The indicator in the data tool includes all respondents who provide any unpaid care, from 1 hour a week to 50 or more.

Calculation None.

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3.7 Carers and social contact Social contact is important for people caring for ill or disabled relatives and loneliness can have an adverse impact on health. This indicator is taken from the Public Health Outcomes Framework and draws on self reported levels of social contact in the Adult Social Care Survey for England.

Coverage and type England only; official statistics.

Sources PHE (2012/13), Public Health Outcomes Framework, 1.18ii - Social Isolation: % of adult carers who have as much social contact as they would like, Public Health England.

Definitions A proportion measure is given for each local authority in England based on the number of people responding to the question "Thinking about how much contact you've had with people you like, which of the following statements best describes your social situation?" with the answer "I have as much social contact as I want with people I like". The indicator shows the number of respondents who did not respond with this particular answer, therefore we can estimate that they are experiencing some degree of social isolation.

Calculation None.

3.8 Smoking prevalence Smoking is one of the most important causes of preventable ill health and premature mortality in the UK. Smoking is a risk factor for many sight threatening eye conditions and generally places additional burden on NHS budgets.

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The prevalence of smoking among persons aged 18 years and over also gives an indication of health inequalities in an area.

Sources PHE (2016), Public Health Outcomes Framework, ‘smoking prevalence’, 2015, Public Health England.

Definitions The number of persons aged 18 and over who are self-reported smokers in the Integrated Household Survey in a local authority. The number of respondents has been weighted by Public Health England in order to improve representativeness of the sample. The weights take into account survey design and non-response.

Calculation None.

3.9 Excessive weight prevalence Many people in the UK are overweight or obese. Excess weight is a leading cause of type 2 diabetes, heart disease and cancer, burdening the NHS budget. Poor health, linked to being overweight, can increase the risk of developing a sight threatening eye condition. The level of excess weight also provides another measure to understand the levels of health inequality in an area.

Sources PHE (2015), Public Health Outcomes Framework, ‘excess weight in adults’, 2014-12, Public Health England.

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Definitions Percentage of adults classified as overweight or obese based on BMI calculations from self-reported height and weight. See Active People Survey source at Sport England website for more information.

Calculation None.

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4. Living with sight loss Over two million people in the UK are living with sight loss that has a significant impact on their daily lives. This figure includes people who are registered blind or partially sighted and those whose sight is just better than the level which qualifies for registration. It also includes people who are awaiting or having treatment and people whose vision could be improved by wearing correctly prescribed glasses.

4.1 Number of people living with sight loss These indicators provide a 2015 population-based estimate for the number of people living with sight loss that has a significant impact on their daily lives. The literature has identified three different categories for the severity of sight loss experienced based on the level of sight loss in the better-seeing eye. The categories are outlined below in the definition section.

Coverage and type All areas; RNIB estimate.

Sources Pezzullo L., Streatfield J., Simkiss P., and Shickle D. (2016). The economic impact of sight loss and blindness in the UK adult population. RNIB and Deloitte Access Economics. Manuscript submitted for publication.

Office for National Statistics (ONS) (2016). Subnational Population Projections, 2014-based projections release. ONS.

Stats Wales (2013). Population projections by local authority and year, 2011-based local authority population projections for Wales. Welsh Government.

Information Services Division (2014). Council Area Population Projections, 2012-based projections releas. NHS Scotland.

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Northern Ireland Statistics and Research Agency (NISRA) (2016). Population projections for areas within Northern Ireland, 2014- based projections release. NISRA.

Boyce T (2012) The Certification and Registration Processes: Stages, barriers and delays. RNIB.

Definition The three categories of severity of sight loss used in this report are taken from the “Future Sight Loss UK 1” report. They are as follows:  Severe sight loss (blindness) is defined as best-corrected visual acuity of <6/60 in the better-seeing eye.  Moderate sight loss (partial sight) is defined as best- corrected visual acuity of <6/18 but better than or equal to 6/60 in the better-seeing eye.  Mild sight loss (partial sight) is defined as best-corrected visual acuity of <6/12 but better than or equal to 6/18 in the better-seeing eye.

These definitions differ from those used in the Certification of Vision Impairment process. Further details about the methodology used to calculate this data can be found in the “Future Sight Loss UK 1” report (Access Economics, 2009). For comparison, further details on the definitions used in the certification process can be found in the “Certification and Registration Processes” report (Boyce, 2012).

The modelling takes into account age, gender, severity and cause of sight loss. However, the modelling does not take into account a number of factors that may influence the results for each area. For example: BME communities; local good practice on the eye care pathway; deprivation, etc.

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National population projections by age and sex are produced for the UK and its constituent countries every two years. The projections are based on the most recently available mid-year population estimates and a set of underlying demographic assumptions regarding future fertility, mortality and migration. The population projections used for 2015, produced by the Office for National Statistics, are based on the 2012 mid-year population estimates.

Calculation Base prevalence rates split by age, gender, severity and cause were taken from the Access Economics “Future Sight Loss UK 1” report. These were applied to ONS 2012-based Subnational Population Projections for 2015, split by age and gender. There are around 600 base prevalence rates in this calculation, further details can be found in the “Future Sight Loss UK 1” report.

4.2 Prevalence of sight loss These indicators provide estimates for how common sight loss is amongst the general population in a given area.

In the raw data tables (worksheet 6), the indicators are named ‘Percentage of people living with sight loss compared to overall population in 2015’.

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Definition The prevalence of sight loss highlights the proportion of the general population estimated to be living with sight loss that has a significant impact on daily lives, at any one point in time.

Age is the key factor in the prevalence of sight loss. Areas that have a larger proportion of older people will have a higher estimated prevalence of sight loss when compared to an area with a younger age profile.

Calculation The prevalence of sight loss for each area was calculated as follows: Prevalence of sight loss = Number of people living with sight loss/Total population from 2015 population projections

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4.3 Future projections of the number of people living with sight loss and the prevalence of sight loss in 2020, 2025 and 2030 The base prevalence rates highlighted in the “Future Sight Loss UK 1” report have been applied to sub-national population projections. This provides an estimate of the projected number of people living with sight loss in 2020, 2025 and 2030.

In the raw data tables, the indicators are named ‘Percentage of people living with sight loss compared to overall population in 2020, 2025, and 2030.’

ONS (2013), Subnational Population Projections for 2020, 2025 and 2030, 2012-based projections release. Office for National Statistics.

Definition See sections 4.1 and 4.2.

Calculation See sections 4.1 and 4.2. The calculation is the same, however it is based on the population projections for 2020, 2025 and 2030.

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5. Certification A Certification of Vision Impairment (CVI) formally certifies a person as either sight impaired (partially sighted) or severely sight impaired (blind). A CVI can only be completed by a consultant ophthalmologist. Once complete, copies are shared with (i) the patient, (ii) Moorfields eye hospital (where the record of CVIs is maintained) and (iii) the local social services team, providing a formal route into social care services for the patient.

It is important to note that the published data shows the incidence of certifications in a single year, not the total certified population. Health authorities do not maintain data on the total certified population.

5.1 Number of Certifications of Vision Impairment These indicators provide an overview of the number of new Certifications of Vision Impairment issued in 2014/15. The data is held by Moorfields eye hospital and published in the Public Health Outcomes Framework (or by Statistics for Wales in Wales).

Coverage and type England and Wales; official statistics.

Sources PHE (2016), Public Health Outcomes Framework Data Tool; indicators on avoidable sight loss. Public Health England.

Statistics for Wales (2015), Eye care statistics for Wales, 2014-15, first release. Statistics for Wales.

ONS (2014), Population Estimates for UK, England and Wales, Mid-2013, Office for National Statistics.

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Definition Details of the eligibility criteria used by consultant ophthalmologists in the certification process can be found in the “Certification and Registration Processes” report (Boyce, 2012).

The CVI forms, help by Moorfields eye hospital, record the location of each patient issued with a CVI. The totals for England and Wales include any “location unknown” and “age unknown” CVI forms.

Calculation There is no calculation for the England CVI data. It is provided as it is published in the Public Health Outcomes Framework.

Welsh CVI data is published by Health Board. To give a figure for the number of CVIs by Welsh local authority, the Health Board data was apportioned out to the constituent local authorities based on mid-2013 population estimates. Local variations in practice will not be picked up in this data. The actual number of CVIs is higher than the sum of all local areas due to some CVIs in the Wales total not being assigned to a Health Board.

Total number of CVIs issued by Welsh local authority = Health Board population/Local authority population x number of CVIs in given Health Board

5.2 Rate of Certifications of Vision Impairment by specific eye conditions The rate of CVIs shows us how many people have experienced sight loss as a result of specific eye conditions out of every 100,000 people in the population (age groups will be specified).

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Sources PHE (2016), Public Health Outcomes Framework Data Tool; indicators on avoidable sight loss. Public Health England.

Statistics for Wales (2015), Eye care statistics for Wales, 2014-15, first release. Statistics for Wales.

Definition Cause of sight loss, age of patient and location are taken from the CVI form, a copy of which is sent to Moorfields Eye Hospital.

The specific indicators are:  Rate of Age related macular degeneration (AMD) CVIs for people aged 65 and over per 100,000 population.  Rate of glaucoma CVIs for people aged 40 and over per 100,000 population.  Rate of diabetic eye disease CVIs for people aged 12 and over per 100,000 population.  Rate of CVIs for all ages per 100,000 population (only available for England).

Full details of how these indicators are calculated can be found on the Public Health Outcomes Framework Data Tool website www.phoutcomes.info.

Calculation None.

5.3 Change in rate of Certifications of Vision Impairment from 2012/13 to 2013/14 How the overall rate of certification (all ages) has changed from 2012/13 to 2014/15.

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Coverage and type England; RNIB estimate.

Sources PHE (2016), Public Health Outcomes Framework Data Tool; indicators on avoidable sight loss: data for 2012/13 - 2014/15. Public Health England.

Definition The Public Health Outcomes Framework Data Tool contains information on the rate of certifications per 100,000 people from 2012/13 to 2014/15. This indicator highlights the percentage change in these rates between the two years.

It cannot be assumed that an increase in the rate of certifications is bad, nor can it be assumed that a decrease in the rate of certifications is a sign of success in tackling avoidable sight loss. Changes in the rate of certifications could be influenced by a range of factors, such as care pathways, data recording or local practice by individual consultants. These are factors that need to be explored locally.

The 2012/13 rate of CVIs for Wales is not included in the data tool therefore the change in rate has not been calculated for Welsh areas.

Calculation The percentage change in the rates of certifications per 100,000 people between 2012/2013 and 2014/2015 was calculated as follows: Percentage change in rate of CVIs = ((Rate of CVIs in 2014/15/Rate of CVIs in 2012/13)-1).

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6. Registration Upon receipt of a completed CVI (BP1 in Scotland), the local social services team will inform the individual with sight loss about the optional registration process and other relevant advice and support. Registers of blind and partially sighted people are maintained by all local authorities to help them plan and deliver services.

6.1 Number of people registered as blind or partially sighted Data on the number of registered blind or partially sighted people in each local area is published each year in Wales and every three years in England. This data is not published in Northern Ireland, and has not been updated in Scotland since 2010.

Registration as blind or partially sighted is voluntary, however it can lead to some benefits and concessions such as blind person’s tax allowance, access to loan equipment and help with the cost of travel. Some benefits are automatic whilst others must be applied for.

If the individual agrees to be registered, social services will contact them to discuss carrying out a needs assessment, also known as a Community Care Assessment. The aim of this assessment is for social services to find out what help and advice is needed to retain independence for the individual. For example, this could include help with everyday tasks such as cooking. Even if registration is declined, social services will still provide support to promote independence.

Coverage and type England, Wales and Scotland; official statistics.

Sources

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HSCIC (2014), Registered Blind and Partially Sighted People - England, Year ending 31 March 2014. Health and Social Care Information Centre.

Welsh Government (2014), Local Authority Registers of People with Disabilities, 2014. Welsh Government.

Scottish Government (2010), Registered Blind and Partially Sighted Persons, Scotland 2010. Scottish Government.

Definitions The register of blind and partially sighted people can be a useful indicator for people living with serious and permanent sight loss. However, there are limitations to the registers which means they are not considered to be a definitive measure of the number of blind and partially sighted people in an area:  CVI are not issued to all eligible patients.  Not all people with a CVI become registered.  There is uncertainty as to how often councils update the register, for example removing people who have died.  People may be living with sight loss that has a significant impact on their daily lives but are not eligible for certification or registration.

Age banding varies between England, Wales and Scotland. The age bands available for areas within these countries are as follows:  England: 0–4; 5–17; 18–49; 50–64; 65–74; 75 and over.  Wales: 0–17; 18–64; 65 and over.  Scotland: 0–64; 65 and over.

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Registration indicators in the Sight Loss Data Tool are only as accurate as the data returned by local authorities to the Health and Social Care Information Centre (publishing source). Some data may not be accurate. In particular, published figures on the number of blind and partially sighted adults and children for Cheshire West and Chester appears to be considerably higher than would be expected from the size of the authority.

Calculation None.

6.2 Proportion of people registered blind or partially sighted also recorded as having an additional disability The register of blind and partially sighted people also records details of any additional disabilities. However, practice varies between local authorities. This indicator highlights the proportion of the registered population that are recorded as having an additional disability and is only published for England.

Coverage and type England; official statistics.

Sources HSCIC (2014), Registered Blind and Partially Sighted People - England, Year ending 31 March 2014. Health and Social Care Information Centre.

Definitions The following broad categories are used to record any additional disabilities:  Hard of Hearing  Deaf without speech  Deaf with speech

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 Physical Disability  Learning Disability  Mental health

It is not clear how complete the additional disability elements of the register of blind and partially sighted people are. It is likely that this will vary considerably between local areas. Therefore, this data is not a definitive measure of the number of people with sight loss and an additional disability and should be interpreted with care.

Calculation The proportion of registered population recorded with an additional disability was calculated as follows: Proportion of registered population with additional disability = (Number of people with additional disability /Total number of registered blind and partially sighted people)

6.3 Rate of registration per 100,000 people This indicator provides data on how many people are registered blind or partially sighted per 100,000 people in the general population.

Coverage and type England, Wales and Scotland; RNIB estimate.

Welsh Government (2014), Local Authority Registers of People with Disabilities, 2014. Welsh Government.

Scottish Government (2010), Registered Blind and Partially Sighted Persons, Scotland 2010. Scottish Government.

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ONS (2014), Population Estimates for UK, England and Wales, Mid-2013, Office for National Statistics,

NRS (2014), Mid-2013 Population Estimates Scotland, National Records of Scotland; NISRA (2014).

Definition See sections 3.1 and 4.1 for definitions of population and registration data.

Calculation The rate of registered blind and partially sighted people per 100,000 people was calculated as follows: Rate of registration per 100,000 people = (Number of people registered as blind or partially sighted /Total population)*100,000

Raw population data was used to calculate the crude rate of registration. No weightings or age standardisation were used in this indicator.

6.4 Percentage change in registration over time These indicators provide data on the percentage change in the number of registered blind and partially sighted people from between 2010/11 and 2013/14 in England and Wales (change between 2008 and 2010 for Scotland).

Sources HSCIC (2014), Registered Blind and Partially Sighted People - England, Year ending 31 March 2014 and 2011. Health and Social Care Information Centre.

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Welsh Government (2014), Local Authority Registers of People with Disabilities, 2014 and 2011. Welsh Government.

Scottish Government (2010), Registered Blind and Partially Sighted Persons, Scotland 2010 and 2008. Scottish Government.

Definition See 4.1 for definitions of registration data. Note: For Denbighshire (Wales), 2010/11 data was missing in earlier publications. Hence, the percentage change in rate of registration was calculated based on the latest data available. The change in rate refers to 2012/13 to 2013/14.

Calculation The percentage change is calculated as follows:

England and Wales: Percentage change = (Number of people registered as blind or partially sighted in 2014/Number of people registered as blind or partially sighted in 2011)-1

Scotland: Percentage change = (Number of people registered as blind or partially sighted in 2010/Number of people registered as blind or partially sighted in 2008)-1

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7. Children and young people We estimate that there are around 25,000 blind and partially sighted children and young people aged 0-16 in the UK, and 15,000 aged 17-25.

Around half of these children and young people will have additional disabilities and/or special educational needs. Many of these children and young people will need help and support in order to maximise their potential in education and in other activities.

7.1 Number and proportion of children and young people These indicators provide information on the number of children and young people in the general population. They are similar to the indicators in the area profiles (section 3), but these indicators use different age banding.

Sources ONS (2016), 2015 mid-year detailed population estimates, Office for National Statistics.

Definitions The age bands used here are 0–16 and 17–25.

See section 3.1 for definitions on the population data.

Calculation The proportion of children and young people in each age band was calculated as follows: Proportion in age band = (Number in age band/Total number of people)

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7.2 Number of blind and partially sighted children and young people (including the number with an additional disability) By applying base prevalence rates to population statistics we are able to estimate the number of blind and partially sighted children and young people by local area. Indicators are provided for both blind and partially sighted children and young people aged 0–16 and 17–25 years.

Sources Keil (2013), Key statistics on number of blind and partially sighted children and young people in England. RNIB.

Morris and Smith (2008), Educational provision for blind and partially sighted children and young people in Britain: 2007. National Foundation for Educational Research (NFER). RNIB.

ONS (2016), 2015 mid-year detailed population estimates, Office for National Statistics.

Definitions The base prevalence of visual impairment in children and young people has been estimated in Morris and Smith (2008) and Keil (2013) to be:  0.05 per cent for blind  0.15 per cent for partially sighted

Based on Morris and Smith (2008) and Keil (2013), we estimate that around half of these children and young people will have an additional disability (0-16 only).

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Calculation The number of children and young people in each age band was calculated as follows: Number of blind children and young people = Total number of children x 0.05%

Number of partially sighted children and young people = Total number of children x 0.15%

Number of children with an additional disability = Total number of blind and partially sighted children x 50% (0-16 age group only)

7.3 Number and proportion of children with visual impairment as primary SEN Children with special educational needs (SEN) who are known to visual impairment services are recorded by the local authority. In England and Scotland this information is published annually, and provides an overview of the number and proportion of pupils who are recorded as having a primary SEN of visual impairment.

Coverage and type England and Scotland; official statistics.

Sources DfE (2016) Special educational needs in England: January 2015. Department for Education.

Scottish Government (2012), Supporting Children's and Young People's Learning: A report on progress of implementation of the Education (Additional Support for Learning) (Scotland) Act 2004. Scottish Government.

Definitions

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In Scotland, only the overall totals are available for inclusion in the data tool.

In England we are able to provide both overall totals and a breakdown by educational setting:  Primary school  Secondary school  Special schools

These indicators only highlight children with visual impairment recorded as their primary SEN. There are likely to be other children with a visual impairment whose primary SEN is recorded under a different disability (and around half of visually impaired children will have an additional disability). Therefore, these indicators are not a definitive measure of the number of blind and partially sighted children in an area.

Calculation None.

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7.4 Local Offer for children and young people sensory service Every local authority in England is expected to have a Local Offer for children with special educational needs, including visually impaired children. The data tool now includes a hyperlink in the full report (sheet 1) that leads directly to the webpage for the local authority’s Local Offer for visual impairment or sensory education services.

Coverage and type England only; RNIB estimate.

Sources RNIB (2016), Local Offer contact information for English local authorities, Evidence and Service Impact.

Definitions Vision impairment in children and young people is a low incidence disability which is likely to have a high impact on their development and learning and within this relatively small population of children there is a wide range of abilities and needs.

A Local Offer gives children and young people with special educational needs or disabilities, and their families, information about what support services will be available in their local area. Every local authority in England is responsible for writing a Local Offer and making sure it is available for everyone to see. This means that anyone can find out what services are available to children and young people with vision impairment and their families in a local authority, and how to contact them. For more information see: http://www.rnib.org.uk/information-everyday-living-education- and-learning-young-childrens-education/special-educational

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The hyperlinks were collected by the RNIB researchers. Where the authority did not have a Local Offer page specific to these services at the time of writing, a general local offer/sensory services link for the authority is provided. Some local services are provided by neighbouring authorities in which case the link to the authority providing the service is given.

Calculation None.

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8. Working age Only around one in four registered blind and partially sighted people of working age are in paid employment (My Voice, 2015, RNIB). It is not currently possible to provide information about employment for blind and partially sighted people at a local level. However, we can provide some information about the local labour market to demonstrate the realities for people living in the area and how sight loss may increase the challenges of entering/maintaining work in the labour market.

8.1 Estimated number of people of working age living with sight loss Estimates for the number of working age people living with sight loss based on the age band: 18-64 years.

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Definitions See section 4.1.

Calculation Base prevalence rates split by age, gender, severity and cause were applied to ONS population projections for 2016, split by age and gender. There are around 600 base prevalence rates in this calculation, further details can be found in the “Future Sight Loss UK 1” report.

Note: The five-year age bands in the population projections did not correspond to the working age group of 18-64. The population aged 18-19 was estimated from the 15-19 age band. This was done by dividing the age band by five to calculate the population of each single age group in the age band, then multiplying by two to give the 18-19 year old figure.

8.2 Number of people of working age registered as blind or partially sighted Data on the number of registered blind or partially sighted people in each local area is published each year in Wales and every three years in England. Registration can be an important route for working age people to access the benefits and concessions to support independent living, working and travel.

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Welsh Government (2014), Local Authority Registers of People with Disabilities. Welsh Government.

The age bands for published registration data for working age people are 18–49 and 50–64 in England. In Wales the age band is 18–64. Data from the Scottish register could not be included in this indicator as the age band of 0-64 is too wide to infer the working age population. Calculation None.

8.3 Unemployment rate of people aged 16-64 It is not possible to provide the unemployment rate of blind and partially sighted people at a local level. However, the general unemployment rate for an area can indicate whether there may be additional challenges in entering the job market in areas of high unemployment.

Sources ONS (2016), UK Labour Market Survey: Unemployment rate - aged 16-64, Office for National Statistics.

Slade J. and Edwards R. (2015), My Voice: The views and experiences of blind and partially sighted people in the UK, RNIB.

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Definitions Data from the UK Labour Market Survey bases the unemployment rate on the number of people not working who have been looking for work within the last 4 weeks and are able to start work within the next 2 weeks as a proportion of the total working age population. The figure does not include all people who are economically inactive such as people not looking for work because they are students, looking after the family or home, because of illness or disability or because they have retired.

Calculation None.

8.4 Proportion of population that drive to work Travel is consistently highlighted as a major issue for blind and partially sighted people and can act as a barrier to accessing employment (My Voice, 2015). Blind and partially sighted people frequently rely on public transport for personal mobility and in many cases not having access to a car (or a very high level of ‘Access to Work’ funding for commuting via taxi) can be a major barrier to employment. In areas with very good public transport links, such as London, the barrier is reduced, however the challenges of public transport still remain an issue for many.

There is no national data available on the challenges faced by blind and partially sighted people in different local travel contexts. However data recorded in the census on the proportion of people who drive to work gives an indication of the importance of car ownership in mobility in different areas, which also indicates the limitations of local public transport links.

Coverage and type All areas; official statistics

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Sources ONS, (2012), 2011 Census: Method of travel to work, local authorities in England and Wales, Office for National Statistics.

Scotland's Census (2011), Method of travel to work of employed people aged 16 to 74 by council area, Scotland

NISRA (2015), Census 2011: Travel to Work: Northern Ireland, Northern Ireland Statistics and Research Agency.

Definitions The 2011 Census asked every person in a household about employment and, if employed, their method of travel to work. This topic is only applicable to people who were in employment in the week before the census. Method of travel was defined as the method used for the longest part, by distance, of the usual journey to work.

The indicator in the data tool shows the proportion of the employed population that drive to work in a car or van. This was calculated by the ONS using the base population from the Census of the number of employed people and their main method of travel to work.

Calculation None.

8.5 Gap in the employment rate between those with a long-term health condition and the overall employment rate

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People who are blind and partially sighted face a range of additional challenges finding and maintaining work. As detailed in the introduction to section 8, the employment rate among blind and partially sighted people is much lower than the general population. However, no local level data is available to understand the absolute numbers.

This indicator instead shows the employment rate among all people with a long term health condition, which will include those people with a visual impairment, compared with the employment rate in the general population. The data is only available for England and it provides more depth of understanding of the situation for people with sight loss of working age at a local level.

Coverage and type England; official statistics

Sources PHE (2014/15) Public Health Outcomes Framework, 1.08i - Gap in the employment rate between those with a long-term health condition and the overall employment rate, Public Health England

Definitions This indicator was taken from the Public Health Outcomes Framework. It is defined as ‘the percentage point gap between the percentage of respondents in the Labour Force Survey who have a long-term condition who are classified as employed (aged 16-64) and the percentage of all respondents in the Labour Force Survey classed as employed (aged 16-64)’.

Calculation None.

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9. Older people As people age, the chance of developing sight loss increases significantly. One in five people aged 75 and over are living with sight loss; compared to one in two aged 90 and over. Older people with sight loss are also much more likely to have additional health conditions or disabilities.

9.1 Number of older people These indicators provide an overview of the number of older people in the population. The data is the same as used in the Area Profile indicators (section 3), and is included for convenience.

Sources ONS (2013), Subnational Population Projections for 2015, 2012- based projections release. Office for National Statistics.

Stats Wales (2013),Population projections by local authority and year, 2011-based local authority population projections for Wales for 2015. Welsh Government.

ISD Scotland (2014), Council Area Population Projections for 2015, 2012-based projections release. Information Services Division, NHS Scotland.

NISRA (2014),Population projections for areas within Northern Ireland, 2012-based projections release. Northern Ireland Statistics and Research Agency.

Definitions The age bands used in these indicators are: 65–74 years; 75–84 years; and 85 years and over.

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Calculation None.

9.2 Number of older people living with sight loss Estimates for the number of older people living with sight loss based on the age bands: 65–74 years; 75–84 years; and 85 years and over. The base data is the same as used for the living with sight loss estimates but for the older age groups.

Sources Access Economics (2009) Future Sight Loss UK 1: The economic impact of partial sight and blindness. RNIB.

ONS (2013), Subnational Population Projections for 2015, 2012- based projections release. Office for National Statistics.

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Calculation Base prevalence rates split by age, gender, severity and cause were applied to ONS population projections for 2015 split by age and gender. There are around 600 base prevalence rates in this calculation, further details can be found in the “Future Sight Loss UK 1” report.

9.3 Number of older people living in care homes Data from the 2011 Census allows us to identify what proportion of the general population live in different types of residence. This indicator uses the data to identify the number of people living in care homes in local authority areas.

Coverage and type All areas; Official statistics.

Sources ONS (2013) 2011 Census: Communal establishment residents, local authorities in England and Wales. Office for National Statistics.

Scottish Government (2012) Scotland’s 2011 Census: Communal establishment residents. Scottish Government.

NISRA (2013) Communal Establishment Residents and Long- Term Health Problem or Disability. Northern Ireland Statistics and Research Agency.

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Definitions The care home categories from the 2011 Census are:  Medical and care establishment: Other: Care home with nursing  Medical and care establishment: Other: Care home without nursing

Calculation None.

9.4 Number of older people registered as blind or partially sighted The majority of registered blind and partially sighted people are over the age of 65. Registers of blind and partially sighted people are maintained by all local authorities to help them plan and deliver services.

The data is the same as used in the Registrations indicators (section 6), and has been included here for convenience.

Sources HSCIC (2014) Registered Blind and Partially Sighted People - England, Year ending 31 March 2014. Health and Social Care Information Centre.

Welsh Government (2014) Local Authority Registers of People with Disabilities, 2014. Welsh Government.

Scottish Government (2010) Registered Blind and Partially Sighted Persons, Scotland 2010. Scottish Government.

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Calculation None.

9.5 Estimated number of older people living with sight loss Estimates for the number of people aged 65 and over living with sight loss split into three age bands:  65-74 years of age  75-84 years of age  85 years of age and over

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Calculation Base prevalence rates split by age, gender, severity and cause were applied to ONS population projections for 2016, split by age and gender. There are around 600 base prevalence rates in this calculation, further details can be found in the “Future Sight Loss UK 1” report.

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10. NHS sight tests Sight tests paid for by the NHS are provided primarily by optometrists to eligible patients, such as children, people aged 60 and over, people on low incomes and some people suffering from, or pre-disposed to, eye disease. The exception is Scotland, where NHS sight tests are universally available to all patients.

Datasets for NHS sight tests are obtained from forms completed by providers, which are a payment mechanism. The nature of the way this data is collected has an impact on the quality of the data, and patients may be eligible for a NHS sight test under multiple eligibility criteria but only one will be recorded.

10.1 Number of NHS sight tests These indicators provide a summary of the number of NHS sight tests conducted in 2014/15 in England and Wales and 2013/14 in Scotland and Northern Ireland.

Coverage and type NHS Area Team in England and Health Boards in Wales, Scotland and Northern Ireland; official statistics.

Sources HSCIC (2014), General Ophthalmic Services, Activity Statistics, England, 2013-14. Health and Social Care Information Centre.

HSCIC (2015), General Ophthalmic Services, Activity Statistics, England, 2014-15. Health and Social Care Information Centre.

ISD Scotland (2014), Ophthalmic Workload Statistics, Scotland, 2013-14. Information Services Division, NHS Scotland.

Welsh Government (2014), NHS ophthalmic statistics by Local Health Board, Wales, 2013-14. Welsh Government.

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HSCNI (2015), General Ophthalmic Service Statistics in Northern Ireland 2013-14. Health and Social Care Northern Ireland.

Definitions The number of 2014/15 NHS sight tests for different eligibility criteria is included in the data tool. The criteria are as follows:  60 years and over  15 years and under  Students aged 16–18 years  NHS sight tests related to benefits  Total number of NHS sight tests

The same data for 2013/14 is included in the raw data spreadsheet (worksheet 9) for trend analysis (not included in the full report or custom tables).

(Note: for Scotland and Northern Ireland, only the total number of NHS sight tests is included. For England and Wales, two years’ worth of data are included in the raw data, the most recent data is included in the full report and custom tables.)

Data on NHS sight tests is not published for local authorities. As a result, data for Area Team or NHS Health Boards is provided. A full list of the local authorities in each NHS Area Team, NHS Health Board and NHS Health and Social Care Trust can be found in Appendix B of these guidance notes.

Calculation None.

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10.2 Rate of NHS sight tests The rate of NHS sight tests is a measure of how many people per 100,000 have had a sight test in the last year. The data is for 2015/16, 2014/15 and 2013/14 for England Wales and Scotland and for 2013/14 for Northern Ireland.

Coverage and type NHS Area Team in England and Health Boards in Wales, Scotland and Northern Ireland; official statistics.

Sources HSCIC (2016), General Ophthalmic Services, Activity Statistics, England, 2015-16. Health and Social Care Information Centre.

ISD Scotland (2016), Ophthalmic Workload Statistics, Scotland, 2015-16 and 2014-15. Information Services Division, NHS Scotland.

ISD Scotland (2014), Ophthalmic Workload Statistics, Scotland, 2013-14. Information Services Division, NHS Scotland.

Welsh Government (2016), NHS Information for Eye Care Wales, 2015-16. Welsh Government.

Welsh Government (2015), NHS Information for Eye Care Wales, 2014-15. Welsh Government.

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HSCNI (2015), General Ophthalmic Service Statistics in Northern Ireland 2013-14. Health and Social Care Northern Ireland.

Definitions Data on NHS sight tests is not published for local authorities in these areas. As a result, data for Area Team or NHS Health Boards is provided. A full list of the local authorities in each NHS Area Team, NHS Health Board and NHS Health and Social Care Trust can be found in Appendix B of these guidance notes.

The rate of NHS sight tests has been included for the following populations in England and Wales, taken from official figures:  All ages  Aged 60 and over  Aged 15 and under

In Scotland and Northern Ireland, the rate of sight tests for all ages only is available.

The rate of sight tests for Scotland was calculated using mid-year population estimates for the year in which the data begun. For example, for 2015/16 data, the mid-year population estimates for 2015 were used. All the estimates are available here.

Calculation None.

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11. Cost of sight loss There are a number of different costs associated with the provision of eye health services, such as inpatient procedures, outpatient appointments and the ongoing treatment of eye conditions. There are also indirect costs caused by sight loss, including the provision of unpaid care to those with sight loss, often provided by family and friends, lower employment and absenteeism.

11.1 Total and proportion of NHS expenditure on problems of vision or ophthalmic services NHS programme budgets provide detailed information on how money was spent on healthcare in England and Wales. This data is a key resource allowing commissioners to see where money is being spent, and it is increasingly being linked to outcome data in order to assess the value for money of outcomes, prioritise and drive reform and quality improvement initiatives.

For the year 2013/14, the cost of sight loss has been published by Clinical Commissioning Group (CCG) in England rather than by Primary Care Trust (PCT), as published in 2012/13. CCGs do not commission the same set of services as previously commissioned by PCTs, therefore not all eye health costs are captured in the new CCG data and the missing data is unpublished. This means that the eye health costs associated with CCGs are not comparable to previous years and do not reflect the true direct cost of sight loss in the CCG area. A full list of the expenditure published by CCG and previously by PCT is available in the Definition section.

In Scotland, NHS expenditure data is provided under different clinical specialities, and the cost of ophthalmic services can be highlighted.

Coverage and type Care Commissioning Groups in England and Health Boards in Scotland and Wales; official statistics.

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Sources NHS England (2015), 2013-14 CCG Programme Budgeting Benchmarking Tool, Indicator 08. Problems of vision. NHS England.

Information Services Division (2014). Scotland National Statistics release, R830: Expenditure on ophthalmic services, by NHS Sector, by board. NHS Scotland.

Statistics for Wales, Ophthalmology, Information Services Division. (2014) NHS expenditure programme budgets, 2013-14, Eye/vision problems. Statistics for Wales.

Definitions Data for England and Wales relates to the “problems of vision” disease category in NHS programme budgets and total programme budget expenditure.

The full list of English PCT services included in the expenditure is detailed below. These services differ from the CCG services included in the expenditure, also detailed in full below.

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Table: Primary Care Trust Care Setting Categories 01.Prevention & Health Promotion 02.Primary Care 03.Primary prescribing 04.Inpatient:Elective and Daycase 05.Inpatient:Non elective 06.Outpatient 07.Other secondary care 08.Total Secondary care 09.Ambulance 10.A&E 11.Community Care 12.Care provided in other setting 13.Non health/social care Table: Clinical Commissioning Group Care Setting Categories 01.Primary Prescribing 02.Unscheduled Care: Non-elective admissions (PBR) 03.Unscheduled Care: A&E 04.Unscheduled Care: Emergency Transport 05.Unscheduled Care: Other Urgent Care 06.Scheduled Care: Daycase and elective (PBR) 07.Scheduled Care Outpatient - (PBR & Non-PBR) 08.Unbundled Diagnostic Imaging 09.Unbundled/high cost: Critical Care 10.Unbundled/high cost: Drugs & devices 11.Unbundled/high cost: Other 12.Direct Access Diagnostic Imaging 13. Total Secondary Care 14.Community and integrated care 15.End of Life Care 16.Running Costs

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For more information on programme budgeting in England, use the following link: https://www.england.nhs.uk/resources/resources-for- ccgs/prog-budgeting/.

For more information on Welsh NHS expenditure, use the following link: http://gov.wales/statistics-and-research/nhs-expenditure- programme-budgets/?lang=en.

Data for Scotland relates to hospital and Family Health Service expenditure related to ophthalmology. This data previously excluded Family Health Service expenditure which was corrected in version 3.2 of the data tool. For more information on Scottish ophthalmology expenditure, use the following link: http://www.isdscotland.org/Health-Topics/Finance/Costs/Detailed- Tables/Ophthalmic-Services.asp.

In England, some CCGs are conterminous with local authorities i.e. Sheffield City Council is conterminous with NHS Sheffield CCG. However, some authorities are covered by multiple CCGs that may overlap with other authorities i.e. Warwickshire is covered by NHS Warwickshire North; NHS South Warwickshire and NHS Coventry and Rugby, however Coventry is covered entirely by NHS Coventry and Rugby.

A full list of CCGs linked to local authorities can be found in Appendix B.

Calculation The proportion of NHS programme budget spent on “problems of vision” was calculated as follows: Proportionate spend on problems of vision = Spend on problems of vision / Total spent

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11.2 NHS expenditure on problems of vision per person Information on the amount of Programme Budget expenditure related to problems of vision per person.

Coverage and type Clinical Commissioning Groups in England and Health Boards in Scotland and Wales; official statistics.

Sources NHS England (2015), 2013-14 CCG Programme Budgeting Benchmarking Tool, Indicator 08. Problems of vision.

ISD (2014) Scotland National Statistics release, R04x: All specialty (exc long stay) summary - by patient type 2013/14,

Ophthalmology, Information Services Division. Statistics for Wales (2014) NHS expenditure programme budgets, 2013-14, Eye/vision problems.

Definitions See section 11.1 for information on NHS Programme Budgets.

Calculation None.

The publishing authorities have calculated the proportion spend for each CCG/Health Board on problems of vision per person based on the population of the area used.

11.3 Total indirect cost of sight loss

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It is estimated that the total indirect cost of sight loss to the UK economy is £5.3 billion each year. This figure has been apportioned out to all the local authorities in the UK based on the prevalence of sight loss in each area.

Sources Access Economics (2009) Future Sight Loss UK 1: The economic impact of partial sight and blindness.

Definitions Indirect costs include a range of costs, the largest element being unpaid care provided to blind and partially sighted people by family and friends. Other significant elements are lower rates of employment and the cost of specialist equipment. Full details can be found in the Access Economics report “Future Sight Loss UK 1”. The total indirect cost of sight loss was estimated at £5.3 billion each year in the report published in 2009.

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See section 4.1 for details on how estimates for the number of people living with sight loss are calculated.

Calculation Indirect cost of sight loss in a local authority = (Number of people living with sight loss in the local authority/Total number of people living with sight loss in the UK) x £5.3 billion

11.4 Indirect cost of sight loss per person Indirect cost of sight loss per person in a local authority, based on total local authority values from calculation in 11.3 and the absolute population in each authority.

Coverage and type All areas, RNIB estimate.

Sources Access Economics (2009) Future Sight Loss UK 1: The economic impact of partial sight and blindness.

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Definitions See section 11.3 for information on the indirect cost of sight loss and section 4.1 for information about population projections.

Calculation Estimated indirect cost of sight loss per person = Total indirect cost of sight loss in local authority / Total population in local authority.

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12. Sight threatening eye conditions There are a number of people who are living with a sight threatening eye condition, or in some cases a number of different sight threatening eye conditions. This includes people who have experienced sight loss as a result of age-related macular degeneration (AMD), cataract, glaucoma and diabetic retinopathy. It also includes people with the early stages of these diseases who have not experienced any reduction in their vision at this point.

12.1 Number of people living with age-related macular degeneration; 2015, 2020, 2025 and 2030 AMD is the leading cause of blindness in the UK, and is the most common cause of sight loss recorded on Certification of Vision Impairment forms. Many more people receive a diagnosis of AMD and are living either with the early or late stages of the disease without certification.

Sources NEHEM (2013) National Eye Health Epidemiological Model. Data and models by Public Health Action Support Team, published by Local Optical Committee Support Unit.

ONS (2013), Subnational Population Projections, 2012-based projections release. Office for National Statistics.

Stats Wales (2013),Population projections by local authority and year, 2011-based local authority population projections for Wales. Welsh Government.

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ISD Scotland (2014), Council Area Population Projections, 2012- based projections release. Information Services Division, NHS Scotland.

Definitions The indicators in the sight loss data tool provide information on:  Early AMD/Drusen  Late stage dry AMD (geographic atrophy AMD)  Late stage wet AMD (neovascular AMD)  Any late stage AMD (wet or dry)

See the National Eye Health Epidemiology Model (NEHEM) for further information about how AMD is defined: www.eyehealthmodel.org. Estimates in the data tool are based on these definitions. However, other definitions may exist in the wider literature or clinical practice.

Calculation Base prevalence rates for AMD split by age and gender are taken from NEHEM and applied to subnational population projections for each country.

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Table: Base prevalence rates for AMD in males Age band Total late Late stage Late stage Early AMD/ stage AMD wet AMD dry AMD Drusen 50-54 0.09% 0.02% 0.06% 3.58% 55-59 0.20% 0.06% 0.11% 4.95% 60-64 0.43% 0.16% 0.22% 6.86% 65-69 0.90% 0.38% 0.51% 9.73% 70-74 1.97% 1.40% 0.56% 12.52% 75-79 4.07% 2.63% 1.91% 18.66% 80+ 6.94% 5.56% 1.39% 23.26%

Table: Base prevalence rates for AMD in females Age band Total late Late stage Late stage Early AMD/ stage AMD wet AMD dry AMD Drusen 50-54 0.21% 0.25% 0.00% 4.36% 55-59 0.37% 0.39% 0.01% 5.89% 60-64 0.64% 0.60% 0.05% 7.97% 65-69 1.03% 0.92% 0.11% 9.89% 70-74 2.36% 1.42% 0.95% 17.29% 75-79 3.15% 2.17% 1.18% 18.09% 80+ 15.00% 10.50% 5.75% 28.86%

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12.2 Number of people living with cataract in 2015, 2020, 2025 and 2030 Cataract surgery is one of the most common surgical procedures performed in the NHS. There are around 400,000 cataract operations in the UK each year. This indicator provides information on the number of people who are estimated to be living with a cataract in one or both eyes.

Cataracts are often correctable. However, until surgery is made available to them, patients will be living with some degree of sight loss which can have an impact on their daily lives.

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Definitions See the National Eye Health Epidemiology Model for further information about how cataract is defined: www.eyehealthmodel.org.

Calculation Base prevalence rates for cataract split by age are taken from NEHEM and applied to subnational population projections for each country.

Table: Base prevalence rates for cataract Age band Prevalence of cataract (low estimate) 40-49 0.04% 50-59 0.17% 60-69 0.81% 70-79 3.91% 80+ 11.73%

12.3 Number of people living with glaucoma in 2015, 2020, 2025 and 2030 Glaucoma is one of the leading causes of avoidable sight loss; and was the main or contributory cause in around 15 per cent of Certifications of Vision Impairment in 2011/12.

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Definitions See the National Eye Health Epidemiology Model for further information about how glaucoma is defined: www.eyehealthmodel.org.

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Calculation Population prevalence rates for glaucoma in each of the UK countries are taken from NEHEM and applied to the relevant 2011 Census and subnational population projections.

Population prevalence rates of glaucoma by country in the UK taken from NEHEM:  England = 1.47 per cent  Northern Ireland = 1.29 per cent  Wales = 1.37 per cent  Scotland = 1.5 per cent

12.4 Number of people living with diabetes in 2015, 2020, 2025 and 2030 Diabetes is a common life-long health condition, where the amount of glucose in the blood is too high, or low, because the body cannot use it properly. Diabetes can lead to diabetic eye disease, including diabetic retinopathy, which in turn can lead to sight loss.

Sources Diabetes UK (2013) Diabetes in the UK 2013. Diabetes UK.

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Definitions The prevalence rates for diabetes taken from a Diabetes UK publication are sourced from the Health Survey for England 2010.

The estimates do not take account of other local factors which may influence prevalence of diabetes such as deprivation, or the ethnic make up of an area.

Calculation Base prevalence rates for diabetes split by age and gender were taken from the ‘Diabetes in the UK 2013’ report and were applied to population estimates from the 2011 Census and the relevant subnational population projections for each country.

Table: Base prevalence rates for diabetes

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Age band Prevalence of Prevalence of diabetes – men diabetes – women 16-34 1.80% 2.10% 35-54 9.40% 6.60% 55-64 11.10% 8.00% 65-74 15.20% 12.20% 75+ 15.90% 13.20%

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12.5 Proportion of patients who were invited to, and attended, a retinal screening appointment Diabetic retinopathy is a significant cause of blindness in the UK, particularly amongst the working age population. Regular screening allows prompt identification of diabetic retinopathy and can lead to potentially sight saving treatment of the disease.

The 2011/12 data is the last data available as Public Health England have removed this indicator from the Public Health Quality Outcomes Framework. This means that valuable data on diabetic eye health is no longer collected and published for service planning purposes at a national level.

Sources Public Health England (2014) Public Health Outcomes Framework Data Tool, Access to non-cancer screening programmes: diabetic retinopathy, 2012/13.

Definitions This indicator highlights the proportion of patients who were offered and attended retinal screening. Some people with diabetes are excluded from the screening programme, and they are not included in this indicator. Someone may be excluded from the screening programme for a number of reasons, for example they may have opted-out, already be attending an eye clinic or have a terminal illness.

Other supporting information related to this indicator can be found on the Public Health Outcomes Framework Data Tool website: www.phoutcomes.info.

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Calculation None.

12.6 Number of people living with diabetic retinopathy and severe diabetic retinopathy in 2015, 2020, 2025 and 2030 Diabetic retinopathy is a complication of diabetes, resulting in damage to the blood vessels in the eye and if left untreated, can lead to sight loss. It is one of the most common causes of sight loss in the UK amongst the working age population. A study carried out by the London School of Hygiene and Tropical Medicine, completed in late 2015, has provided new robust estimates for the prevalence of diabetic retinopathy in the UK population.

Coverage and type All areas; RNIB estimate. Sources R. Mathur et al (2015), Diabetic eye disease: A UK Incidence and Prevalence Study, London School of Hygiene and Tropical Medicine. (currently unpublished)

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Definitions The research was carried out on a nationally representative sample from the Clinical Practice Research Datalink (CPRD) which contains the records of millions of patients. The ‘Read clinical coding system’, which is a hierarchical system of medical coding used across UK primary care, was used to identify diabetic retinopathy. Diabetic retinopathy was classified as severe if the codes pertained to laser therapy, advanced retinopathy, preproliferative or proliferative retinopathy.

The overall prevalence of the eye condition in the population in the year 2014 was applied to the relevant sub national population projections. The prevalence was not adjusted for 2020, 2025 or 2030 projections. This means the projections do not take account of any increases in the prevalence of Type 2 diabetes in the population which, if current trends continue, may increase in the future.

The full “Diabetic eye disease” report is due to be released after the research has been published in a peer review journal. In the interim, for more information on the clinical definitions used, please contact us on [email protected].

Calculation Population prevalence rates for diabetic retinopathy and severe diabetic retinopathy were applied to the relevant sub-national population projections for the local authority.

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The prevalence rates used were:  Diabetic retinopathy = 2.39%  Severe diabetic retinopathy = 0.22%

The prevalence rates apply to the general UK population aged 12 years old and older. For the purposes of the RNIB estimate, the 2015 sub-national population projections were used for consistency with other indicators in the tool. However the projections are only available in five year age bands. Hence, the prevalence rates were applied to the population aged fifteen years old or older. The true prevalence will be slightly higher given that the population aged 12, 13 and 14 have not been included in the estimate.

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13. Support The provision of emotional and practical support at the right time can help people who are experiencing sight loss to retain their independence and access the support they need.

13.1 Ophthalmology outpatient appointments When diagnosed with an eye condition, patients attend a hospital appointment with an ophthalmology specialist. However, only a small proportion of these appointments will involve patients diagnosed with serious sight loss. Outpatient appointment data is published at various levels across different UK health authorities.

Coverage and type NHS Trust level in England, Health Board level in Scotland and Wales and Hospital level in Northern Ireland; official statistics.

Sources HSCIC (2016) Outpatients - Provider level analysis 2015/16, Table 8: Hospital provider attendances broken down by main specialty, Health and Social Care Information Centre.

HSCIC (2015), Outpatients - Provider level analysis 2014-15, Table 8: Hospital provider attendances broken down by main specialty, Health and Social Care Information Centre.

HSCIC (2014), Outpatients - Provider level analysis 2013-14, Table 8: Hospital provider attendances broken down by main specialty, Health and Social Care Information Centre.

ISD (2015), Scotland National Statistics release, Specialty Group Costs - Consultant Outpatients 2006/07 - 2015/16, Information Services Scotland.

Statistics for Wales (2016) Outpatient attendances by organisation and site; Total attendances 2015/16, Statistics for Wales.

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Statistics for Wales (2016), Information for Eye Care, 2015-16, Table 9: Number of outpatient appointments (new and follow up) for ophthalmology by year and Health Board 2014/15. Statistics for Wales.

Statistics for Wales (2015), Information for Eye Care, 2014-15, Table 9: Number of outpatient appointments (new and follow up) for ophthalmology by year and Health Board 2008/09 - 2013/14. Statistics for Wales.

DHSSPS (2016), Hospital Statistics: Outpatient Activity Statistics 2009/010 - 2015/16, Department of Health, Social Services and Public Safety.

Definitions Published outpatient statistics contain individual records for all outpatient appointments occurring in the site. All outpatient attendances recorded against the ophthalmology reference code are included in the ophthalmology statistics. These will include first appointments and repeat appointments.

The outpatient data in Scotland and Wales is published at Health Board level. These have been linked to local authorities in the full report.

The outpatient data in England is published at NHS Area Team and NHS Trust level (Area Teams are made up of a number of Trusts). Data has been included in the data tool at both of these levels. For English NHS Trusts, only the top 150 Trusts by ophthalmic footfall were included in the dataset. These account for 99 per cent of all appointments. Trusts outside of this have minimal appointments (around 120 additional Trusts and treatment centres). Area Team level data is also provided, however this data will include some appointments from outside of the top 150 Trusts which make up the England total.

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There are 16 hospital centres in Northern Ireland offering ophthalmology services for which outpatient figures are published. Hospitals have been linked to Health and Social Care Trusts to enable reporting in the full report. A list of the Trusts linked to hospitals can be found in Appendix B.

Calculation The number of outpatient appointments in England is not published at Area Team level.

To give total appointments by Area Team, the appointment numbers for the top 150 Trusts (by number of appointments) were summed for each Area Team. A small number of appointments not within the top 150 Trusts will not appear in the Area Team totals England hence the sum of all Area Teams will not match the England total.

13.2 Ophthalmology waiting times from referral to treatment Referral to Treatment Time is the period of time from referral by a general practitioner or other medical practitioner to hospital for treatment in the NHS in Wales. The NHS Outcomes Framework 2016-17 is used to measure delivery.

Coverage and type Welsh Health Board, official statistics.

Sources Stats Wales (2016), Patient pathways waiting to start treatment by month and grouped weeks: Ophthalmology, Statistics for Wales.

Definitions

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These indicators are based on the number of patient pathways waiting to start treatments within the ophthalmology treatment function, at Welsh Health Board level. A patient pathway is the point from referral to treatment. Some patients may have more than one pathway, hence the data does not represent the number of patients but the number of patient pathways.

The indicators cover two snapshots of data. The number of patient pathways waiting to start treatment in November 2015 and in November 2016. These two points are provided for comparison.

The number of patients awaiting treatment is provided along with the proportion of these pathways which, at that point in time, had a waiting time longer than the 26 week target.

Further trend data is available from Statistics for Wales.

Calculation None.

13.3 Number of Trusts with eye clinic support in England / Access to eye clinic support Scotland, Wales and Northern Ireland Patient experience in the eye clinic can be important for future independence. It is here that people receive their diagnosis, undergo treatment and potentially go through the process of receiving a Certificate of Vision Impairment. Support from a qualified advisor at any of these stages may be invaluable to someone experiencing sight loss.

These indicators highlight the number of NHS Trusts in England, and Health Boards in Scotland, Wales and Northern Ireland, where emotional and practical support from a sight loss advisor was available. Sight loss advisors are also known as an eye clinic liaison officers (ECLOs) or vision support officers (VSOs).

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Coverage and type NHS Trust level in England, Health Board level in Scotland and Wales and Health and Social Care Trust level in Northern Ireland; RNIB estimate.

Sources RNIB (2016), Mapping of RNIB-qualified sight loss advisors in the UK. Unpublished.

Definitions The data in this version of the data tool is correct, to our best knowledge, as of March 2017. Plans to update the data are outlined at the end of the definitions section.

A Trust or Health Board was recorded as having eye clinic support in place if:  a sight loss advisor is employed at a clinic within the Trust/Board and;  the sight loss advisor has attended the RNIB Eye Clinic Support Studies Course, accredited by City University London. Attendance at this course is required to be recognised by RNIB as fully qualified in providing quality emotional and practical support to patients with sight loss.

This indicator does not take into account support available from other sources, which may be varying in quality. For instance, advisors may have been in place at some Trusts, but the role may have been voluntary or been occupied by an advisor who had not attended the accredited course. The indicator also does not take into account the varying sizes of eye clinics and whether the support in place was sufficient to meet demand.

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Systematic research was undertaken to identify Trusts/Health Boards with qualified eye clinic support. RNIB made use of the network of sight loss advisors who have been on the course and local early intervention support networks to identify where support was available. Where there were no local networks, RNIB contacted clinics by telephone to enquire about the support in place.

In Scotland, Wales and Northern Ireland, the data was collected at Health Board/Health and Social Care Trust level. For this reason, the data items by Board/Trust were recorded as ‘yes’ or ‘no’, depending on whether there was or wasn’t access to a qualified sight loss advisor.

In England, RNIB collected data for the top 150 English NHS Trusts by ophthalmic footfall. These Trusts account for 99 per cent of all appointments. Trusts outside of this have minimal ophthalmic appointments and are not included in the dataset. In the raw data, a ‘1’ next to the Trust indicates that a paid, qualified sight loss advisor was in place at the Trust. A ‘0’ indicates that a paid, qualified sight loss advisor was not place at the Trust (at the time of data collection).

Data for this indicator will be updated every three months.

Calculation None.

13.4 Rehabilitation support – visual impairment

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Visual impairment rehabilitation is an intervention delivered by specialist professionals to support people with sight loss to be as independent as possible. Rehabilitation Officers help people to maximise their functional vision and skills for confident daily living. These indicators are based on responses to a Freedom of Information (FOI) request made in early 2014 by RNIB to all local authorities in England responsible for providing rehabilitation support for visual impairment. The first indicator outlines whether a structured programme of rehabilitation support was available to residents and the second outlines the number of rehabilitation officers employed by the local authority or their contracted service provider.

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Coverage and type England only; RNIB estimate.

Sources RNIB (2014), Rehabilitation services Freedom of Information request to all English local authorities, Jan 2014.

Definitions The data is based on responses to an FOI request made of all local authorities in England in early 2014. All responses were received by April 2014 with the exception of some local authorities who did not return any data (signified by an ‘x’ in the raw data for a non-response or where the answer was unclear).

The first indicator outlines whether the authority offered blind and partially sighted people a structured programme of rehabilitation. In the raw data, a ‘1’ indicates that the authority did provide this; a ‘0’ indicates that the authority did not provide this; and an ‘x’ indicates non-response or an unclear response.

The second indicator outlines the number of full time rehabilitation officers and assistants of visual impairment that were employed by the authority (or their contracted service provider). Responses were varied and included part time workers for which no full time equivalence was stated. Responses also included a range of job titles including Enablement Officer, Sensory Equipment Officers, Community Assessment Officers, Social Workers, voluntary/unqualified Rehabilitation Advisors (for instance, in Hampshire over half of the 25-27 officers are unqualified Sensory Officers) and Dual Sensory Loss Officers. A range is provided in the data tool rather than the exact number of officers listed in the FOI responses to allow for discrepancies in the varied responses.

Any additional local information or knowledge should be used in conjunction with this data. If you would like to make us aware of any additional information on rehabilitation services in a local authority, get in touch with us on [email protected].

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Note: District Councils do not provide rehabilitation services; this is provided by County Councils. Therefore, no data was collected from District Councils (these are recorded with an ‘x’ in the raw data, worksheet 8).

Note: The rehabilitation service provided in Bedford Borough Council is the same as the service provided in Central Bedfordshire. The same number of rehabilitation officers are recorded for each authority, however these officers are shared between the two authorities.

Calculation None.

13.5 Number and proportion of blind and partially sighted people in receipt of Disability Living Allowance Disability Living Allowance (DLA) is a benefit paid to help people with the extra costs incurred as a result of a disability, and it is paid at different rates depending on the level of need.

Sources NOMIS (2016), DWP, Benefit claimants - disability living allowance by disabling condition May 2016, Department for Work and Pensions.

HSCIC (2014) Registered Blind and Partially Sighted People - England, Year ending 31 March 2014. Health and Social Care Information Centre.

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Welsh Government (2014) Local Authority Registers of People with Disabilities, 2014. Welsh Government.

Scottish Government (2010) Registered Blind and Partially Sighted Persons, Scotland 2010. Scottish Government.

Definitions Data on the number of Disability Living Allowance claimants by disabling conditions in May 2016 is used in this indicator.

Calculation Blindness and Deaf Blind categories are combined to provide a total for blind and partially sighted people.

The proportion of the registered population in receipt of DLA is calculated using the following calculation: Proportion of registered population in receipt of DLA = (Number of DLA claimants under "blindness" /Total number of registered blind and partially sighted people)

13.6 Number of blind and partially sighted people in receipt of adult social care services Social care involves the provision of help with personal care and domestic tasks to enable people to live as independently as possible. This care can be provided in people's own homes or in a residential setting. This indicator relates to social care provided or paid for by councils with responsibilities for social care.

Sources

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NASCIC (2014) Adult social care: Referrals, Assessments and Packages of Care data, 2013/14, 2005/06, National Adult Social Care Information Centre.

Definitions The indicator uses the Referrals, Assessments and Packages of Care dataset to estimate the number of blind and partially sighted people in receipt of social care in 2013/14 and 2005/06.

Calculation Blindness and Deaf Blind categories are combined to provide a total for blind and partially sighted people.

13.7 Proportion of adult social care users who do not have as much social contact as they would like Social contact is important for ill or disabled people or people who need support to live independently. Public health research has found that loneliness can have a negative impact on health. This indicator is taken from the Public Health Outcomes Framework and draws on self-reported levels of social contact in the Adult Social Care Survey for England. See the framework for more information on the impact of loneliness on healthcare budgets.

Sources PHE (2013/14) Public Health Outcomes Framework, 1.18i - Social Isolation: per cent of adult social care users who have as much social contact as they would like. Public Health England.

Definitions

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This measure, taken from the Public Health Outcomes Framework, draws on self-reported levels of social contact as an indicator of social isolation for users of social care. Data for this indicator was taken from responses to the Adult Social Care Users Survey (2013/14) question "Thinking about how much contact you've had with people you like, which of the following statements best describes your social situation?" The indicator outlines the proportion with the answer "I have as much social contact I want with people I like". Respondents who did not give this answer are included in the data tool to give an indication of the proportion who do not have as much social contact as they would like. Note: these respondents may have answered that they have less social contact than they would like; may have answered ‘Don’t know’ or may have declined to answer the question.

Calculation The indicator shows the proportion of adult social care users with as much social contact as they would like. To show the reverse of this for people who do not have as much social contact as they would like, the proportion was subtracted from one hundred per cent.

13.8 Number of blue badges issued and held by people registered blind

Blue Badges’ are parking badges for disabled people. Local authorities issue them to individuals and organisations concerned with the care of disabled people. Upon issue, a Blue Badge is valid for a period of three years. People who are registered as blind are automatically entitled to a blue badge if they register for one (i.e. there will be no further assessment of need as with many other applicants).

Sources

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Department for Transport Statistics (2016), Blue badge scheme statistics: 2016, data tables, DfT.

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Definitions Blue badge data is held by local authorities and published by the Department for Transport. Not all local authorities return a full set of data hence there are gaps for some local authorities.

The available data is for the registered blind population who are automatically entitled to a blue badge if they apply for one because of their disability status. Data on the number of blue badges issued over a period of six years is included in the data tool to enable trends to be tracked given the badges are valid for a period of three years once issued. Data on the number of blue badges held in 2016 is also provided in the data tool. The rate of blue badges held in 2016 was calculated by the Department for Transport and is included for context to show what proportion of registered blind people hold a blue badge.

Calculation None.

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14. Falls and other health conditions and disabilities This section provides an overview of falls indicators and some of the common additional health problems that can impact on blind and partially sighted people. Indicators are provided on falls, dementia, stroke and hearing impairment.

14.1 Falls These indicators provide estimates on the number of people aged 65 and over who have experienced at least one fall in a year. Further estimates are provided for the number of serious falls that required hospital admission. We can use this data on falls within the general population to estimate the number of blind and partially sighted people who fell each year and how many falls were directly attributable to sight loss.

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POPPI (2013), Projecting Older People Population Information System. Institute of Public Care for the Department of Health.

Boyce T, Stone MK, Johnson S and Simkiss P (2013), Projecting numbers of falls related to visual impairment. British Journal of Healthcare Management Vol 19 No 6.

Scuffham, P. et al, (2003), Incidence and costs of unintentional falls in older people in the United Kingdom, Journal of Epidemiology and Community Health, Vol. 57, No.9, Sept. 2003, pp.740-744

Definition Number of falls is defined in the literature as people who reported having fell at least once during the last 12 months.

Number of falls that required hospital admission is based on a study of A&E admissions (Scuffham, P. et al, 2003).

Calculation Prevalence rates for people who report falls or falls that required hospital admission were obtained from POPPI and were applied to subnational population projections. Methodology from Boyce et al. (2013) was then applied to estimate the number of blind and partially sighted people who (i) suffered a fall and (ii) the number of falls that were directly attributable to sight loss.

The number of falls (65 and over) (i) which occurred and (ii) were directly attributed to visual impairment were calculated as follows:  Number of falls which occurred in individuals with visual impairment = 8.04 per cent of total number of falls (taken from POPPI estimate).  Number of falls which can be directly attributed to the visual impairment = 3.80 per cent of total number of falls (taken from POPPI estimate).

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Table: Base prevalence rates for falls in the general population by age and gender

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Age range Percentage of Percentage of males reporting a females reporting a fall fall 65–69 18% 23% 70–74 20% 27% 75–79 19% 27% 80–84 31% 34% 85+ 43% 43%

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Table: Base prevalence rates for falls that require hospital admission by age

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Age range Percentage of population with a fall requiring hospital admission 65–69 0.52% 70–74 0.92% 75+ 3.68%

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14.2 Dementia and sight loss These indicators provide estimates on the number of people aged 65 and over in the general population who are living with dementia and the number of people over 75 who are living with dementia and significant sight loss.

Thomas Pocklington Trust (2007), Dementia and serious sight loss, Occasional paper February 2007, number 11. Thomas Pocklington Trust.

Definition

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The term dementia describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language.

More information on the definitions of this data can be found on registering with the POPPI website at http://www.poppi.org.uk/.

Calculation A prevalence rate was used to estimate the number of people living with dementia that also have significant sight loss. The prevalence rate was taken from Thomas Pocklington Trust research, 2007, and was applied to subnational population projections for the over 75s. The prevalence rate taken from the research suggests that 2.5 per cent of people over the age of 75 have dementia and serious sight loss.

Prevalence rates for dementia in the general population, split by age and sex, were taken from POPPI and applied to subnational population projections.

Table: Base prevalence rates for dementia by age and gender (POPPI)

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Age range Percentage of Percentage of males with females with dementia dementia 65–69 1.5% 1.0% 70–74 3.1% 2.4% 75–79 5.1% 6.5% 80–84 10.2% 13.3% 85–89 16.7% 22.2% 90+ 27.9% 30.7%

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14.3 Stroke These indicators provide estimates on the number of people aged 65 and over who have a longstanding health condition caused by a stroke.

General Household Survey 2007, table 7.14 Chronic sickness: rate per 1000 reporting selected longstanding conditions, by sex and age, Office for National Statistics.

Definition

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A stroke happens when the supply of blood to an area of brain tissue is interrupted, for example, by a blood clot or a bleed. When starved of oxygen, the affected brain cells start to die and a brain injury occurs which can lead to a disability.

Based on survey data where participants were asked if they had experienced a stroke (General Household Survey, 2007).

More information on the definitions of this data can be found on registering with the POPPI website at http://www.poppi.org.uk/.

Calculation Base prevalence rates for stroke, split by age and gender, were taken from POPPI and applied to subnational population projections.

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Table: Base prevalence rates for stroke resulting in a longstanding health condition by age and gender

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Age range Percentage of Percentage of males reporting a females reporting a stroke stroke 65–74 2.8% 1.2% 75+ 3.8% 1.9%

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14.4 Hearing impairment These indicators provide an overview of the number of people living with hearing impairment by severity in the UK.

Davis A (Ed.), Hearing in Adults (1995), Whurr Publishers Limited.

Davis A et al, Health Technology Assessments 11(42):1-294 (October 2007). Health Technology Assessments.

Definition

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Hearing impairment is measured by finding the quietest sounds someone can hear using tones with different frequencies. Hearing thresholds are measured in decibels hearing levels (dBHL). Anyone with thresholds between 0 and 20 dBHL across all the frequencies is considered to have 'normal' hearing. The greater the threshold level is in dBHL the worse the hearing loss.  Moderate hearing impairment: The quietest sounds that can be heard in the better ear is on average between 35 and 49 decibels.  Severe deafness hearing impairment: The quietest sounds that can heard in better ear is on average between 50 and 94 decibels.  Profound deafness hearing impairment: The quietest sounds that can be heard in the better ear is on average 95 decibels or more.

The POPPI prevalence rates were taken from the combined prevalence from the two Davis studies listed in the sources.

Calculation Base prevalence rates for hearing impairment, split by age and gender, were taken from POPPI and applied to subnational population projections.

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Table: Base prevalence rates for moderate or severe and profound hearing loss by age and gender

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Age range Percentage Percentage Percentage Percentage of males of females of males of females with with with with moderate moderate profound profound or severe or severe hearing hearing hearing hearing loss loss loss loss 20–24 0.18% 0.24% 0.0% 0.0% 25–34 0.0% 0.95% 0.0% 0.0% 35–44 0.78% 2.09% 0.0% 0.0% 45–54 7.15% 4.13% 0.0% 0.09% 55–64 14.81% 8.09% 0.12% 0.13% 65–74 22.69% 15.79% 0.43% 0.78% 75–84 60.63% 63.43% 0.41% 0.80% 85+ 85.05% 84.8% 3.45% 4.73%

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14.5 Dual sensory loss This indicator provides an overview of the number of people living with hearing impairment by severity in the UK.

Robertson J and Emerson E (2010), Estimating the Number of People with Co‐ Occurring Vision and Hearing Impairments in the UK. Centre for Disability Research.

Definition

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Dual sensory loss is a combination of sight and hearing loss and people with the condition are often also described as deafblind, multi-sensory impaired or dual-sensory impaired. A person is regarded as deafblind if their combined sight and hearing impairment cause difficulties with communication, access to information and mobility. This includes people with a progressive sight and hearing loss. The estimates are based on findings from eight large scale UK surveys using self-reporting methods.

These estimates include people with differing levels of hearing loss and sight loss. Because of this varying combination of sensory loss, the estimates are not detailed enough to split out people who are severely sight impaired, profoundly deaf or both, from the wider group.

However, the research does provide an estimate for more and less severe dual sensory impairment. The less severe estimate includes both the severe cases and less severe cases. The severe estimate includes only severe cases. The prevalence rates for both of these categories can be found in the calculation section. The range of hearing and sight loss conditions associated with the more severe estimate are listed in the table below. The less severe impairment estimate will include the same conditions with the addition of more general dual sensory loss self-reporting questions. For more information, please refer to the source which can be found on the Sense website here.

Table: Health Conditions Associated with more severe sensory loss estimate

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Hearing Impairment: lower Vision Impairment: lower limit limit estimate estimate Cataract/poor eye Poor hearing/deafness: sight/blindness: Conductive/nerve/noise induced Incl. operation for cataracts, now deafness need glasses Bad eyesight, restricted vision, Deaf mute/deaf and dumb partially sighted Bad eyesight/nearly blind Heard of hearing, slightly deaf because of cataracts Otosclerosis Blind in one eye, loss of one eye Poor hearing after mastoid operation Blindness caused by diabetes Blurred vision Detached/scarred retina Hardening of lens Lens implants in both eyes Short sighted, long sighted, myopia Trouble with eyes, eyes not good Tunnel vision

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Calculation Base prevalence rates for dual sensory loss, split by age and gender, were taken from the Robertson and Emerson study (2010) and applied to subnational population projections.

Table: Base prevalence rates for dual sensory loss by age and gender

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Upper estimate – less Lower estimate – more severe and more severe severe impairment impairment Men with Women Men with Women dual with dual dual with dual Age sensory sensory sensory sensory range loss loss loss loss 0.052% 0.020%

0‐9 0.33% 0.09%

0.016% 0.029%

10‐19 0.11% 0.05%

0.036% 0.124%

20‐29 0.06% 0.03%

0.009% 0.013%

30‐39 0.07% 0.06%

0.020% 0.029%

40‐49 0.13% 0.22%

0.053% 0.043%

50‐59 0.50% 0.32%

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0.499% 0.073%

60‐69 1.25% 0.47%

0.413% 0.628%

70‐79 1.06% 1.45%

1.770% 1.305%

80‐89 4.03% 4.42%

90+ 12.62% 13.41% 12.757% 5.571%

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14.6 Number of people registered with dual sensory loss

The register of blind and partially sighted people in England also collects data on additional disabilities. The data for people with an additional sensory disability has been used for this indicator.

Coverage and type England; official statistics.

Sources HSCIC (2014), Registered Blind and Partially Sighted People - England, Year ending 31 March 2014, Number of blind and partially sighted people with additional disability. Health and Social Care Information Centre.

Definition Hearing impairment data taken from the register of blind and partially sighted people is a valuable indicator to understand the number of people living with different levels of sensory disability in local areas. The indicators in the data tool includes people who are blind and partially sighted and also:  Deaf with speech  Deaf without speech  Hard of hearing  Deaf with or without speech (the sum of the first two deaf categories)  Deaf with or without speech and hard of hearing (the sum of the first three categories)

Calculation None.

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14.7 Number of adults with a learning disability and visual impairment Visual impairments are more common among people with learning disabilities, especially people with more severe learning disabilities, and that the presence of visual impairments can significantly impair the independence and quality of life of people with learning disabilities.

Emerson and Hatton (2004), Estimating the Current Need/Demand for Supports for People with Learning Disabilities in England. Lancaster: Institute for Health Research, Lancaster University, 2004.

Emerson and Robertson (2011), The Estimated Prevalence of Visual Impairment among People with Learning Disabilities in the UK. RNIB.

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Definition This indicator provides an estimate of the number of people in the UK with a learning disability and a visual impairment. The figures are based on national prevalence estimates that have been applied to local population data.

Caution should be taken when interpreting figures at a local level as factors contributing to local variations have not been included in the model.

The figures include:  The number of people with a learning disability and a visual impairment  The number of people with a learning disability and blindness

Calculation Research commissioned by the Department of Health (Emerson and Hatton, 2004) produced prevalence estimates for the number of adults with a learning disability in the UK population. This figure is wider than the number of adults with learning disabilities in administrative datasets as not all will access services.

These base prevalence estimates were applied to local level population data for the UK by age group and gender (Emerson and Hatton, 2004).

Table: Base estimated prevalence rates for learning disabilities in adults by age and gender

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Age range Male Female 20-24 3.09% 2.11% 25-29 2.84% 1.98% 30-34 2.87% 1.97% 35-39 2.82% 1.95% 40-44 2.86% 1.95% 45-49 2.66% 1.84% 50-54 2.51% 1.74% 55-59 2.44% 1.74% 60-64 2.34% 1.62% 65-69 2.17% 1.46% 70-74 2.08% 1.42% 75-79 1.89% 1.25% 80+ 1.86% 1.23%

Base estimated prevalence rates of visual impairment and blindness in the population of adults with a learning disability were then applied to the population of adults with a learning disability (Emerson and Robertson, 2011). The report defines visual impairment as visual acuity ≤6/18. Blindness impairment was defined as visual acuity ≤6/60. See the report for further information.

Table: Base estimated prevalence rates for visual impairment in adults with learning disabilities by age and level of impairment Age VI Blind excluding blind 20-49 4.80% 1.60% 50+ 10.86% 2.79%

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15. Benchmarking Indicators Benchmarking indicators for each country within the UK have been calculated and are presented in a brand new report for version 3 of the data tool. The report allows users to compare benchmarked figures across two groupings – region/country or deprivation decile (England only). These figures allow users to compare key statistics to the national average and identify where there is a statistical difference in the data to strengthen their evidence base.

The region/country function allows users to select one of nine English regions or a UK country (excluding England). A report will be generated that compares all the local authorities in the region/country to the country national average. The deprivation deciles function classifies all local authorities in England into ten groups ranging from the most deprived to the least deprived local authorities using the indices of multiple deprivation (see section 3.3 for more information on the indices of multiple deprivation). This report only uses the England benchmarking figures (not the Wales, Scotland and Northern Ireland figures) because of incomparable deprivation data and the large number of local authorities in England. A list linking all English local authorities to the appropriate deprivation decile can be found in worksheet ‘3.1 Deprivation Deciles’ in the Sight Loss Data Tool.

The report displays six different indicators that are available in the data tool but have been converted into a rate per 100,000 or 1,000 per population for comparison purposes. Confidence intervals have been generated for all local authorities against the country benchmark and the report displays whether the rates are similar, lower or higher than the national average with text and coloured cells. Confidence intervals are important for benchmarking as they allow users to identify where figures are statistically different from the national average, rather than just identifying whether the figure is higher or lower than the average.

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Public Health England describes a confidence interval as a range of values that is used to quantify the imprecision in the estimate of a particular value (PHE, 2008). In public health, the conventional confidence interval limits are set at 95% confidence, hence 95% confidence has been used in the benchmarking data calculation. Where the confidence interval of the national average and the local area in question do not overlap, there is a statistically significant difference.

By finding a difference in the width of both confidence intervals, we can rule out imprecision that arises as a result of ‘natural’ variation in the population to a 95% confidence level. i.e. 19 times out of 20, the true figure will lie within the confidence interval range.

A West Midlands Public Health Observatory excel tool was applied to determine the confidence intervals (WMPHO, year unknown). It uses the same calculation as used for other common public health statistics. The tool was called ‘RATECI’ and further information can be found at the following link: http://www.wmpho.org.uk/tools/.

The six indicators in the benchmarking report are listed below.

15.1 People aged 75+ (rate per 1,000) Sight loss becomes more common in the population as people get older which is why the population aged 75 years old and older in an area offers a good indication of the demand for sight loss services.

Coverage and type All areas; official statistics and RNIB estimate.

Sources ONS (2014), Population Estimates for UK, England and Wales, Mid-2013, Office for National Statistics.

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NRS (2014), Mid-2013 Population Estimates Scotland, National Records of Scotland.

NISRA (2014), Population and Migration Estimates 2013, Northern Ireland Statistics and Research Agency.

PHE (2008),Technical Briefing 3: Commonly Used Public Health Statistics and their Confidence Intervals, Public Health England.

WMPHO (year unknown), Excel 97-2003 Add-In, “UDF_RateCI_9703.xla”, West Midlands Public Health Observatory.

Definition The rate of people who were 75 years old or older in the general population was calculated from the 2013 mid-year population estimates. This provided a rate per 1,000 people who were 75+.

Upper and lower confidence intervals were calculated for all areas. Then, the confidence intervals for the 75+ rate in each of the four UK countries were used as benchmarks for their constituent local authorities. Local authorities with an upper or lower confidence interval that overlapped with the benchmark are recorded as ‘similar’ to the benchmark. Local authorities with an upper confidence interval below the benchmark’s lower confidence interval are recorded as ‘lower’ than the benchmark. Local authorities with a lower confidence interval above the benchmark’s upper confidence interval are recorded as ‘higher’ than the benchmark.

Calculation The rate of people 75 and over per 1,000 people was calculated as follows: Rate 75 and over per 1,000 people = (Population 75 years old and older /Total population) x 1,000

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The West Midlands Public Health Observatory confidence interval tool was used to calculate the upper and lower confidence intervals based on the number of people aged 75 and over and the total population (WMPHO, year unknown).

15.2 People from BME groups (rate per 1,000) People from black and minority ethnic (BME) groups can be at a greater risk of some of the leading causes of sight loss including glaucoma and diabetic retinopathy. Barriers to accessing health services and general deprivation may also be greater among some minority ethnic communities.

Coverage and type All areas; official statistics and RNIB estimate.

Sources ONS (2012), 2011 Census: Key Statistics for local authorities in England and Wales, Ethnic group. Office for National Statistics.

NRS (2013), 2011 Census: Ethnic groups. National Records of Scotland.

NISRA (2013), 2011 Census: Ethnicity, Identity, Language and Religion. Northern Ireland Statistics and Research Agency.

Definition

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The rate of people from BME groups in the general population was calculated from 2011 Census data. This provided a rate per 1,000 people who were from BME groups.

Upper and lower confidence intervals were calculated for all areas and benchmarked against the four UK countries national average confidence intervals. Areas were recorded as ‘higher’, ‘lower’ or ‘similar’ to the national benchmark, as described in section 15.1.

Calculation The rate of people from BME groups per 1,000 people was calculated as follows: Rate of people from BME groups per 1,000 people = (BME population /Total population) x 1,000

The West Midlands Public Health Observatory confidence interval tool was used to calculate the upper and lower confidence intervals based on the number of people from BME groups and the total population (WMPHO, year unknown).

15.3 Living with sight loss – 2015 (rate per 1,000) Estimates for the number of people living with sight loss, described in section 4, have been calculated as a rate per 1,000 in the population. This gives an indication of the relative populations of different areas living with sight loss which affects their everyday lives.

Sources

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Pezzullo L., Streatfield J., Simkiss P., and Shickle D. (2016). The economic impact of sight loss and blindness in the UK adult population. RNIB and Deloitte Access Economics. Manuscript submitted for publication.

Definition The rate of people living with sight loss in the general population was calculated from the living with sight loss estimates described in section 4 and subnational population projection data for 2015. All people living with sight loss were included in the figure (i.e. those with mild, moderate or severe sight loss). This provided a rate per 1,000 people who were living with sight loss.

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Upper and lower confidence intervals were calculated for all areas and benchmarked against the four UK countries national average confidence intervals. Areas were recorded as ‘higher’, ‘lower’ or ‘similar’ to the national benchmark as described in section 15.1.

Calculation The rate of people living with sight loss in 2015 per 1,000 people was calculated as follows: Rate of people living with sight loss per 1,000 people = (Population living with mild, moderate or severe sight loss /Total population) x 1,000

The West Midlands Public Health Observatory confidence interval tool was used to calculate the upper and lower confidence intervals based on the number of people living with sight loss in 2015 and the total population (WMPHO, year unknown).

15.4 Living with sight loss – 2030 (rate per 1,000)

Projections for the number of people living with sight loss, described in section 4, have been calculated as a rate per 1,000 in the population. This gives an indication of the relative populations of different areas that will be living with sight loss that affects their everyday lives in 2030.

Sources ONS (2013), National Population Projections for 2030, 2012-based projections release. Office for National Statistics.

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Pezzullo L., Streatfield J., Simkiss P., and Shickle D. (2016). The economic impact of sight loss and blindness in the UK adult population. RNIB and Deloitte Access Economics. Manuscript submitted for publication.

Definition The rate of people living with sight loss in the general population was calculated from the living with sight loss projections calculated in section 4 and sub-national population projection data for 2015. All people living with sight loss were included in the figure (i.e. those with mild, moderate or severe sight loss). This provided a rate per 1,000 people who were living with sight loss in 2030.

Upper and lower confidence intervals were calculated for all areas and benchmarked against the four UK countries national average confidence intervals. Areas were recorded as ‘higher’, ‘lower’ or ‘similar’ to the national benchmark as described in 15.1.

Calculation The rate of people living with sight loss in 2030 per 1,000 people was calculated as follows: Rate of people living with sight loss per 1,000 people = (Population living with mild, moderate or severe sight loss /Total population) x 1,000

The West Midlands Public Health Observatory confidence interval tool was used to calculate the upper and lower confidence intervals based on the number of people living with sight loss in 2030 and the total population in 2030 (WMPHO, year unknown).

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15.5 Certifications of Vision Impairment 2013/14 (rate per 100,000) Certification of Vision Impairment (CVI) occurs when someone’s level of sight meets clinical definitions of sight impairment or severe sight impairment. The published data shows the incidence of certifications in a single year (not the total population with a CVI). For more information, see section 5.

The rate of certifications per 100,000 population in a given year demonstrates the proportion of people certified in that year. When considered alongside other benchmarked indicators, such as the estimated number of people living with sight loss, this can unveil potential differences in health contexts or clinical certification practices in different areas. For instance, where the estimated rate of the population living with sight loss is higher than the benchmarked figure, one would expect that incidence of certification would be higher than the benchmarked figure also. However, when this is not the case (i.e. where the rate of certification is similar to or lower than the benchmarked figure), this indicates that there may be differences in the context or practices in that area when compared with the national average. This is where knowledge of the local health context and clinical practices may shed light on why the data shows something unexpected.

Coverage and type England only; official statistics and RNIB estimate.

Sources Public Health England (2016), Public Health Outcomes Framework Data Tool; indicators on avoidable sight loss: data for 2011/12 - 2014/15.

Definition The rate of certifications of vision impairment in the general population was calculated by Public Health England for the Public Health Outcomes Framework. This provides a rate per 100,000 people.

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Calculation None for the rate of certifications.

The West Midlands Public Health Observatory confidence interval tool was used to calculate the upper and lower confidence intervals based on the number of certifications and the total population (WMPHO, year unknown).

15.6 Blind and partially sighted register (rate per 100,000) When people receive a Certification of Vision Impairment, they become eligible to be registered as blind or partially sighted (however not all do register). The rate of registration in the general population gives an indication of the proportion of people who are registered in the local authority as blind or partially sighted. For more information on registrations, see section 6.

Coverage and type England, Wales and Scotland only; official statistics and RNIB estimate.

Sources HSCIC (2014), Registered Blind and Partially Sighted People - England, Year ending 31 March 2014 and 2011. Health and Social Care Information Centre.

Scottish Government (2010), Registered Blind and Partially Sighted Persons, Scotland 2010 and 2008. Scottish Government.

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Welsh Government (2014), Local Authority Registers of People with Disabilities, 2014 and 2011. Welsh Government.

ONS (2014), Population Estimates for UK, England and Wales, Mid-2013, Office for National Statistics.

NRS (2014), Mid-2013 Population Estimates Scotland, National Records of Scotland.

Definition The rate of registration per 100,000 people calculated in section 6.3 was used to produce the benchmarking figures. See section 6.3 for more information.

Note: The population data for Scotland is for the year 2013 while the registration data is for the year 2010. This is a minor disparity which may reduce the proportional rate of registration per 100,000, though by an imperceptible figure.

Calculation See section 6.3 for calculation of rate of registration per 100,000 people.

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The West Midlands Public Health Observatory confidence interval tool was used to calculate the upper and lower confidence intervals based on the number of people registered and the total population (WMPHO, year unknown).

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Appendix A – Additional resources This section provides information on some other useful data tools and resources. This is not a comprehensive list.

1. Toolkits and guides for using data

Effective eye care commissioning www.commissioningforeyecare.org.uk

The UK Vision Strategy has published guidance to support commissioners. The resource includes a range of information, including data sources and key policy documents. Search ‘JSNA’ on the website for a template for including eye care commissioning in local Joint Strategic Needs Assessments.

Making disability data work for you http://odi.dwp.gov.uk/fulfilling-potential/toolkit.php

The Office for Disability Issues has published a new toolkit showing the different published datasets for people with disabilities and potential uses of the datasets. The toolkit aims to help organisations find and use data to support their work.

English health boundaries http://webarchive.nationalarchives.gov.uk/20160105160709/http:// www.ons.gov.uk/ons/guide-method/geography/beginner-s- guide/eurostat/index.html

The Office for National Statistics has a wealth of information on English health boundaries, explaining current and previous structures. Lookup tables are also provided linking various health geographies to local authority areas.

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2. Directory of services

Sightline directory www.sightlinedirectory.org.uk

The Sightline directory is an online directory of services and organisations that help blind and partially sighted people in the UK. The directory is maintained by RNIB.

3. Other useful data tools

Cataract Mapping www.mycataracts.co.uk

Alcon Eye Care UK have produced an interactive website that provides patients, the public and health professionals with easy-to- access information about waiting times for cataract surgery and access to new technology in their area.

Child Health Profiles www.chimat.org.uk/profiles

Child health profiles provide a snapshot of child health and wellbeing for each local authority in England, using key health indicators. Users can compare this information to local, regional and national data.

Commissioning for Value www.england.nhs.uk/resources/resources-for-ccgs/comm-for- value/

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Data packs published by NHS England for each Clinical Commissioning Group and area team. These packs aim to help commissioners to access data, evidence and tools to help them make decisions and plan services for patients and populations in their areas.

Daffodil www.daffodilcymru.org.uk

Daffodil provides information to help plan care services in Wales. Information from research and population projections show potential need for care over the next 20 years for children, adults and older people.

Diabetes Watch https://diabeteswatch.diabetes.org.uk/

Diabetes Watch shows users the standard of diabetes care across the UK compared to the national average. It uses national data for England, Wales and Scotland, from annually updated publications.

Health Profiles www.healthprofiles.info/

Health Profiles is a programme to improve availability and accessibility for health and health-related information in England. The profiles give a snapshot overview of health for each local authority in England. Health Profiles are produced annually. They are designed to help local government and health services make decisions and plans to improve local people's health and reduce health inequalities. The profiles present a set of health indicators that show how the area compares to the national average.

Local Health www.localhealth.org.uk

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Developed by Public Health England, the Local Health resource provides interactive maps for a number of indicators from ward to local authority level.

Longer Lives Data Tool http://longerlives.phe.org.uk/

Longer Lives highlights premature mortality across every local authority in England, giving people important information to help them improve their community’s health.

National Eye Health Epidemiological Model www.eyehealthmodel.org.uk

The National Eye Health Epidemiological Model (NEHEM) provides information of the number of people living with age- related macular degeneration, glaucoma, cataract and low vision. The tool is customisable, providing users with the option to input their own base prevalence rates or population data.

National General Practice Profiles http://fingertips.phe.org.uk/

These profiles are designed to support GPs, clinical commissioning groups (CCGs) and local authorities to ensure that they are providing and commissioning effective and appropriate healthcare services for their local population.

Nomis www.nomisweb.co.uk

Nomis is an online database of UK labour market statistics. This includes a wealth of data from Jobcentre Plus, the Labour Force Survey and benefits such as Disability Living Allowance and Attendance Allowance.

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Older People’s Health and Wellbeing Atlas www.wmpho.org.uk/olderpeopleatlas

The Older People’s Health and Wellbeing Atlas provides a snapshot profile of each local authority in England. Interactive maps and charts enable comparisons to be made nationally for over 100 indicators. The atlas can be used to highlight deficits in the health and care of older people and large variations between local authorities across England. The information will be of use to the wide range of organisations with an interest in the health and care of older people.

PANSI www.pansi.org.uk

Projecting Adult Needs and Service Information (PANSI) provides access to projections of the numbers, characteristics and care needs of people aged 18–64 in England at national, regional and council level.

POPPI www.poppi.org.uk

Projecting Older People Population Information (POPPI) provides access to projections of the numbers, characteristics and care needs of people over 65 in England at national, regional and council level.

Public Health Outcomes Framework Tool www.phoutcomes.info

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The Public Health Outcomes Framework sets out a vision for public health, desired outcomes and the indicators that will help us understand how well public health is being improved and protected. The framework concentrates on two high-level outcomes to be achieved across the public health system, and groups further indicators into four ‘domains’ that cover the full spectrum of public health.

This tool currently presents data for available indicators at England and upper tier local authority levels, collated by Public Health England.

StatsWales https://statswales.wales.gov.uk

StatsWales is the Welsh Government’s free-to-use online repository for detailed statistical data for Wales. The system covers nearly 1,000 datasets, including key information on a wide range of topics such as population, education, health and disability.

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Appendix B – Geographical Areas This section provides a summary of all of the geographical areas covered in the Sight Loss Data Tool. This includes regions and health areas.

Government Office Regions have been used to group English local authorities throughout the data tool. The Nomenclature of Territorial Units for Statistics (NUTS) classifications were used to group local authorities in Scotland, Wales and Northern Ireland in to regions. Wales was divided into only two regions, these were each split in two based on the geography of the local authorities. NUTS was created by the European Office for Statistics (Eurostat) as a single hierarchical classification of spatial units used for statistical production across the European Union (EU). Please consult the Office for National Statistics website for further information on the NUTS classification system.

For more information see: http://webarchive.nationalarchives.gov.uk/20160105160709/http:// www.ons.gov.uk/ons/guide-method/geography/beginner-s- guide/eurostat/index.html

1. England Regions

North East Darlington; Durham; Hartlepool; Middlesbrough; Northumberland; Redcar & Cleveland; Stockton-on-Tees; Gateshead; Newcastle- upon-Tyne; North Tyneside; South Tyneside; Sunderland.

North West Cumbria; Lancashire; Blackburn with Darwen; Blackpool; Cheshire East; Cheshire West and Chester; Halton; Warrington; Bolton; Bury; Knowsley; Liverpool; Manchester; Oldham; Rochdale; Salford; Sefton; St Helens; Stockport; Tameside; Trafford; Wigan; Wirral.

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Yorkshire and the Humber North Yorkshire; East Riding; Kingston-upon-Hull; North East Lincolnshire; North Lincolnshire; York; Barnsley; Bradford; Calderdale; Doncaster; Kirklees; Leeds; Rotherham; Sheffield; Wakefield.

East Midlands Derbyshire; Leicestershire; Lincolnshire; Northamptonshire; Nottinghamshire; Derby; Leicester; Nottingham; Rutland.

West Midlands Staffordshire; Warwickshire; Worcestershire; Herefordshire; Shropshire; Stoke-on-Trent; Telford and Wrekin; Birmingham; Coventry; Dudley; Sandwell; Solihull; Walsall; Wolverhampton.

South West Devon; Dorset; Gloucestershire; Somerset; Bath & N E Somerset; Bournemouth; Bristol; Cornwall; Isles of Scilly; North Somerset; Plymouth; Poole; South Gloucestershire; Swindon; Torbay; Wiltshire.

East Cambridgeshire; Essex; Hertfordshire; Norfolk; Suffolk; Bedford; Central Bedfordshire; Luton; Peterborough; Southend; Thurrock.

London Camden; Greenwich; Hackney; Hammersmith & Fulham; Islington; Kensington & Chelsea; Lambeth; Lewisham; Southwark; Tower Hamlets; Wandsworth; Westminster; City of London; Barking & Dagenham; Barnet; Bexley; Brent; Bromley; Croydon; Ealing; Enfield; Haringey; Harrow; Havering; Hillingdon; Hounslow; Kingston-upon-Thames; Merton; Newham; Redbridge; Richmond- upon-Thames; Sutton; Waltham Forest.

South East

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Buckinghamshire; East Sussex; Hampshire; Kent; Oxfordshire; Surrey; West Sussex; Bracknell Forest; Brighton & Hove; Isle of Wight; Medway Towns; Milton Keynes; Portsmouth; Reading; Slough; Southampton; West Berkshire; Windsor & Maidenhead; Wokingham.

2. Scotland Regions Eastern Scotland Angus; Clackmannanshire; Dundee City; East Lothian City of Edinburgh; Falkirk; Fife; Midlothian; Perth & Kinross; Scottish Borders; Stirling; West Lothian.

North Eastern Scotland Aberdeen City; Aberdeenshire.

Highlands and Islands Argyll and Bute; Eilean Siar; Highland; Moray; Orkney Islands; Shetland Islands.

South Western Scotland Dumfries & Galloway; East Ayrshire; East Dunbartonshire; East Renfrewshire; Glasgow City; Inverclyde; North Ayrshire; North Lanarkshire; Renfrewshire; South Ayrshire; South Lanarkshire; West Dunbartonshire.

3. Wales Regions Mid and West Wales Powys; Ceredigion; Pembrokeshire; Carmarthenshire.

North Wales Isle of Anglesey; Gwynedd; Conwy; Denbighshire; Flintshire; Wrexham.

South Central Wales

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The Vale of Glamorgan; Cardiff; Rhondda Cynon Taf.

South East Wales Merthyr Tydfil; Caerphilly; Blaenau Gwent; Torfaen; Monmouthshire; Newport.

South West Wales Swansea; Neath Port Talbot; Bridgend.

4. Northern Ireland Regions Eastern Northern Ireland Antrim and Newtownabbey; Mid and East Antrim.

West and South Northern Ireland Armagh, Banbridge and Craigavon; Fermanagh and Omagh; Mid Ulster; Newry, Mourne and Down.

Belfast and Outer Belfast Belfast; Lisburn and Castlereagh; North Down and Ards.

Northern Northern Ireland Causeway Coast and Glens; Derry and Strabane.

5. NHS Area Team and NHS Trust (England) The data tool assigns English local authorities to one of 25 NHS Area Teams containing a number of local authorities. A list matching local authorities to Area Teams can be found in the first table below. Some authorities belong to more than one area team.

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The data tool also contains a selection of NHS Trusts with high numbers of ophthalmology outpatient appointments. Trusts have not been matched to local authority given that each authority may include residents who are referred to a range of neighbouring trusts depending on the service required. However, the trusts have been matched to area team for reporting in the data tool by local authority. This list can be found in the second table below.

Reference Table 1: Local authority to Area Team

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Area Team Local Authorities Arden, Bromsgrove; Coventry; Herefordshire; Herefordshire and Malvern Hills; North Warwickshire; Nuneaton Worcestershire and Bedworth; Redditch; Rugby; Stratford- Area Team on-Avon; Warwick; Warwickshire; Worcester; Worcestershire; Wychavon; Wyre Forest Bath, Bath and North East Somerset; Cheltenham; Gloucestershire, Cotswold; Forest of Dean; Gloucester; Swindon and Gloucestershire; Oxfordshire; Stroud; Wiltshire Area Swindon; Tewkesbury; Vale of White Horse; Team Wiltshire Birmingham and Birmingham; Dudley; Sandwell; Solihull; the Black Country Walsall; Wolverhampton Area Team Bristol, North Bristol, City of; Mendip; North Somerset; Somerset, Sedgemoor; Somerset; South Somerset and Gloucestershire; South Somerset; Taunton South Deane; West Somerset Gloucestershire Area Team Cheshire, Cheshire East; Cheshire West and Chester; Warrington and Warrington; Wirral; Allerdale Wirral Area Team Cumbria, Allerdale; Barrow-in-Furness; Carlisle; Northumberland, Copeland; Craven; Cumbria; Eden; Tyne and Wear Gateshead; Newcastle upon Tyne; North Area Team Tyneside; North Yorkshire; Northumberland; South Lakeland; South Tyneside; Sunderland Derbyshire and Amber Valley; Ashfield; Bolsover; Broxtowe; Nottinghamshire Chesterfield; Derby; Derbyshire; Derbyshire Area Team Dales; Erewash; Gedling; High Peak; Mansfield; Newark and Sherwood; North East Derbyshire; Nottingham; Rushcliffe; South Derbyshire Devon, Cornwall Cornwall; Devon; East Devon; Exeter; Isles and Isles of Scilly of Scilly; Mid Devon; North Devon; Plymouth; Area Team South Hams; Teignbridge; Torbay; Torridge; West Devon

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Durham, Darlington County Durham; Darlington; Hartlepool; and Tees Area Middlesbrough; Redcar and Cleveland; Team Stockton-on-Tees East Anglia Area Babergh; Breckland; Broadland; Cambridge; Team Cambridgeshire; East Cambridgeshire; East Northamptonshire; Fenland; Forest Heath; Great Yarmouth; Hertfordshire; Huntingdonshire; Ipswich; King's Lynn and West Norfolk; Mid Suffolk; Norfolk; North Hertfordshire; North Norfolk; Northamptonshire; Norwich; Peterborough; South Cambridgeshire; South Norfolk; St Edmundsbury; Suffolk; Suffolk Coastal; Waveney Essex Area Team Basildon; Braintree; Brentwood; Castle Point; Chelmsford; Colchester; Epping Forest; Essex; Harlow; Maldon; Rochford; Southend- on-Sea; Tendring; Thurrock; Uttlesford Greater Bolton; Bury; Manchester; Oldham; Manchester Area Rochdale; Salford; Stockport; Tameside; Team Trafford; Wigan Hertfordshire and Bedford; Broxbourne; Central Bedfordshire; the South Midlands Corby; Dacorum; Daventry; East Area Team Hertfordshire; Hertfordshire; Hertsmere; Kettering; Luton; Milton Keynes; Northampton; Northamptonshire; South Northamptonshire; South Northamptonshire; St Albans; Stevenage; Three Rivers; Watford; Wellingborough; Welwyn Hatfield Kent and Medway Ashford; Canterbury; Dartford; Dover; Area Team Gravesham; Kent; Maidstone; Medway; Sevenoaks; Shepway; Swale; Thanet; Tonbridge and Malling; Tunbridge Wells Lancashire Area Blackburn with Darwen; Blackpool; Burnley; Team Chorley; Fylde; Hyndburn; Lancashire; Lancaster; Pendle; Preston; Ribble Valley; Rossendale; South Ribble; West Lancashire; Wyre

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Leicestershire and Blaby; Boston; Charnwood; East Lindsey; Lincolnshire Area Harborough; Hinckley and Bosworth; Team Leicester; Leicestershire; Lincoln; Lincolnshire; Melton; North Kesteven; North West Leicestershire; Oadby and Wigston; Rutland; South Holland; South Kesteven; West Lindsey London Area Team Barking and Dagenham; Barnet; Bexley; Brent; Bromley; Camden; City of London; Croydon; Ealing; Enfield; Greenwich; Hackney; Hammersmith and Fulham; Haringey; Harrow; Havering; Hillingdon; Hounslow; Inner London; Islington; Kensington and Chelsea; Kingston upon Thames; Lambeth; Lewisham; Merton; Newham; Redbridge; Richmond upon Thames; Southwark; Sutton; Tower Hamlets; Waltham Forest; Wandsworth; Westminster Merseyside Area Halton; Knowsley; Liverpool; Sefton; St. Team Helens North Yorkshire East Riding of Yorkshire; Hambleton; and Humber Area Harrogate; Kingston upon Hull; North East Team Lincolnshire; North Lincolnshire; North Yorkshire; Richmondshire; Ryedale; Scarborough; Selby; York Shropshire and Cannock Chase; East Staffordshire; Lichfield; Staffordshire Area Newcastle-under-Lyme; Shropshire; South Team Staffordshire; Stafford; Staffordshire; Staffordshire Moorlands; Stoke-on-Trent; Tamworth; Telford and Wrekin South Yorkshire Barnsley; Bassetlaw; Doncaster; and Bassetlaw Nottinghamshire; Rotherham; Sheffield Area Team Surrey and Sussex Adur; Arun; Brighton and Hove; Chichester; Area Team Crawley; East Sussex; Eastbourne; Elmbridge; Epsom and Ewell; Guildford; Hastings; Horsham; Lewes; Mid Sussex; Mole Valley; Reigate and Banstead; Rother; Spelthorne; Surrey; Surrey Heath; Tandridge;

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Wealden; West Sussex; Woking; Worthing Thames Valley Aylesbury Vale; Bracknell Forest; Area Team Buckinghamshire; Cherwell; Chiltern; Oxford; Oxfordshire; Reading; Runnymede; Slough; South Bucks; South Oxfordshire; Surrey; West Berkshire; West Oxfordshire; West Oxfordshire; Windsor and Maidenhead; Wokingham; Wycombe Wessex Area Basingstoke and Deane; Bournemouth; Team Christchurch; Dorset; East Dorset; East Hampshire; Eastleigh; Fareham; Gosport; Hampshire; Hart; Havant; Isle of Wight; New Forest; North Dorset; Poole; Portsmouth; Purbeck; Rushmoor; Southampton; Surrey; Test Valley; Waverley; West Dorset; Weymouth and Portland; Winchester West Yorkshire Bradford; Calderdale; Kirklees; Leeds; Area Team Wakefield

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Reference Table 2: NHS Trust to Area Team

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NHS Area Team NHS Trust (Top 150 in ophthalmology appointment numbers) Arden, George Eliot Hospital NHS Trust; Heart of Herefordshire and England NHS Foundation Trust; South Worcestershire Warwickshire NHS Foundation Trust; Area Team University Hospitals Coventry and Warwickshire NHS Trust; Worcestershire Acute Hospitals NHS Trust; Worcestershire Health and Care NHS Trust; Wye Valley NHS Trust Bath, Gloucestershire Hospitals NHS Foundation Gloucestershire, Trust; Great Western Hospitals NHS Swindon and Foundation Trust; Royal United Hospital Bath Wiltshire Area NHS Trust; Salisbury NHS Foundation Trust Team Birmingham and Birmingham Children's Hospital NHS the Black Country Foundation Trust; Nuffield Health, Area Team Wolverhampton Hospital; Sandwell and West Birmingham Hospitals NHS Trust; The Dudley Group NHS Foundation Trust; The Royal Wolverhampton NHS Trust; University Hospitals Birmingham NHS Foundation Trust; Walsall Healthcare NHS Trust Bristol, North Shepton Mallet NHS Treatment Centre - Somerset, Care UK; Taunton and Somerset NHS Somerset and Foundation Trust; University Hospitals Bristol South NHS Foundation Trust; Weston Area Health Gloucestershire NHS Trust; Yeovil District Hospital NHS Area Team Foundation Trust Cheshire, Countess of Chester Hospital NHS Warrington and Foundation Trust; East Cheshire NHS Trust; Wirral Area Team Mid Cheshire Hospitals NHS Foundation Trust; Warrington and Haltom Hospitals NHS Foundation Trust; Wirral University Teaching Hospital NHS Foundation Trust Cumbria, City Hospitals Sunderland NHS Foundation Northumberland, Trust; South Tyneside NHS Foundation Tyne and Wear Trust; North Cumbria University Hospitals Area Team NHS Trust; The Newcastle Upon Tyne

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Hospitals NHS Foundation Trust

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Derbyshire and Chesterfield Royal Hospital NHS Foundation Nottinghamshire Trust; Derby Hospitals NHS Foundation Area Team Trust; Derbyshire Community Health Services NHS Trust; Nottingham University Hospitals NHS Trust; Sherwood Forest Hospitals NHS Foundation Trust Devon, Cornwall Bodmin NHS Treatment Centre; Northern and Isles of Scilly Devon Healthcare NHS Trust; Plymouth Area Team Hospitals NHS Trust; Royal Cornwall Hospitals NHS Trust; Royal Devon and Exeter NHS Foundation Trust; South Devon Healthcare NHS Foundation Trust Durham, Darlington County Durham and Darlington NHS and Tees Area Foundation Trust; Nuffield Health, Tees Team Hospital; South Tees Hospitals NHS Foundation Trust East Anglia Area Cambridge University Hospitals NHS Team Foundation Trust; Cambridgeshire Community Services NHS Trust; Hinchingbrooke Health Care NHS Trust; Ipswich Hospital NHS Trust; James Paget University Hospitals NHS Foundation Trust; Norfolk and Norwich University Hospitals NHS Foundation Trust; Peterborough And Stamford Hospitals NHS Foundation Trust; The Queen Elizabeth Hospital, King's Lynn, NHS Foundation Trust; West Suffolk NHS Foundation Trust Essex Area Team Braintree Community Hospital; Colchester Hospital University NHS Foundation Trust; Mid Essex Hospital Services NHS Trust; Southend University Hospital NHS Foundation Trust; The Princess Alexandra Hospital NHS Trust Greater Bolton NHS Foundation Trust; Central Manchester Area Manchester University Hospitals NHS Team Foundation Trust; Pennine Acute Hospitals NHS Trust; Spamedica (Citygate); Stockport NHS Foundation Trust; Tameside Hospital

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NHS Foundation Trust; Wrightington, Wigan And Leigh NHS Foundation Trust

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Hertfordshire and Kettering General Hospital NHS Foundation the South Midlands Trust; Northampton General Hospital NHS Area Team Trust; Woodland Hospital; Bedford Hospital NHS Trust (provided by Moor fields); Clinicenta Surgicentre; East and North Hertfordshire NHS Trust; Luton and Dunstable University Hospital NHS Foundation Trust; West Hertfordshire Hospitals NHS Trust; Milton Keynes Hospital NHS Foundation Trust Kent and Medway Ashford and St Peter's Hospitals NHS Area Team Foundation Trust; East Kent Hospitals University NHS Foundation Trust; Maidstone and Tunbridge Wells NHS Trust; Will Adams NHS Treatment Centre Lancashire Area Blackpool Teaching Hospitals NHS Team Foundation Trust; East Lancashire Hospitals NHS Trust; Lancashire Teaching Hospitals NHS Foundation Trust; The Croft Shifa Health Centre; University Hospitals of Morecambe Bay NHS Foundation Trust Leicestershire and United Lincolnshire Hospitals NHS Trust; Lincolnshire Area University Hospitals of Leicester NHS Trust Team London Area Team Barking, Havering and Redbridge University Hospitals NHS Trust; Barnet And Chase Farm Hospitals NHS Trust; Barts Health NHS Trust; Chelsea And Westminster Hospital NHS Foundation Trust; Croydon Health Services NHS Trust; Great Ormond Street Hospital For Children NHS Foundation Trust; Guy's And St Thomas' NHS Foundation Trust; Imperial College Healthcare NHS Trust; Kings College Hospital NHS Foundation Trust; Kingston Hospital NHS Foundation Trust; Lewisham and Greenwich NHS Trust; Moorfields Eye Hospital NHS Foundation Trust; North East London Treatment Centre Care Uk; North Middlesex

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University Hospital NHS Trust; North West London Hospitals NHS Trust; Royal Free London NHS Foundation Trust; South London Healthcare NHS Trust (provided by Kings College Hosp); The Hillingdon Hospitals NHS Foundation Trust; The Whittington Hospital NHS Trust; University College London Hospitals NHS Foundation Trust

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Merseyside Area Aintree University Hospital NHS Foundation Team Trust; Alder Hey Children's NHS Foundation Trust; Royal Liverpool and Broadgreen University Hospitals NHS Trust; Southport And Ormskirk Hospital NHS Trust; St Helens and Knowsley Hospitals NHS Trust North Yorkshire Harrogate and District NHS Foundation and Humber Area Trust; Hull and East Yorkshire Hospitals NHS Team Trust; Northern Lincolnshire and Goole NHS Foundation Trust; York Teaching Hospital NHS Foundation Trust Shropshire and Burton Hospitals NHS Foundation Trust; Mid Staffordshire Area Staffordshire NHS Foundation Trust; Team Shrewsbury and Telford Hospital NHS Trust; University Hospitals of North Midlands NHS Trust South Yorkshire Barnsley Hospital NHS Foundation Trust; and Bassetlaw Doncaster and Bassetlaw Hospitals NHS Area Team Foundation Trust; Sheffield Children's NHS Foundation Trust; Sheffield Teaching Hospitals NHS Foundation Trust; The Rotherham NHS Foundation Trust Surrey and Sussex Brighton and Sussex University Hospitals Area Team NHS Trust; Cobham Day Surgery Hospital; East Sussex Healthcare NHS Trust; Epsom and St Helier University Hospitals NHS Trust; Frimley Park Hospital NHS Foundation Trust; Queen Victoria Hospital NHS Foundation Trust; Royal Surrey County Hospital NHS Foundation Trust; Surrey and Sussex Healthcare NHS Trust; Western Sussex Hospitals NHS Foundation Trust Thames Valley Buckinghamshire Healthcare NHS Trust; Area Team Oxford University Hospitals NHS Trust; Royal Berkshire NHS Foundation Trust Wessex Area Dorset County Hospital NHS Foundation Team Trust; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust; Hampshire Hospitals NHS Foundation

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Trust; Isle of Wight NHS Trust; Portsmouth Hospitals NHS Trust; Southern Health NHS Foundation Trust; St Mary's NHS Treatment Centre; University Hospital Southampton NHS Foundation Trust West Yorkshire Airedale NHS Foundation Trust; Bradford Area Team Teaching Hospitals NHS Foundation Trust; Calderdale and Huddersfield NHS Foundation Trust; Leeds Teaching Hospitals NHS Trust; Mid Yorkshire Hospitals NHS Trust

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6. Clinical Commissioning Group (England)

Reference Table 3: Local authority to Clinical Commissioning Group

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Local Authority Care Commissioning Group Barking and Dagenham NHS Barking & Dagenham Barnet NHS Barnet Barnsley NHS Barnsley NHS Bath and North East Bath and North East Somerset Somerset Bedford NHS Bedfordshire Bexley NHS Bexley NHS Sandwell and West Birmingham; NHS Birmingham CrossCity; NHS Birmingham Birmingham South and Central Blackburn with Darwen NHS Blackburn with Darwen Blackpool NHS Blackpool Bolton NHS Bolton Bournemouth NHS Dorset Bracknell Forest NHS Bracknell and Ascot NHS Airedale, Wharfedale and Craven; NHS Bradford City; Bradford NHS Bradford Districts Brent NHS Brent Brighton and Hove NHS Brighton & Hove Bristol, City of NHS Bristol Bromley NHS Bromley NHS Aylesbury Vale; NHS Buckinghamshire Milton Keynes; NHS Chiltern Bury NHS Bury Calderdale NHS Calderdale NHS Cambridgeshire and Cambridgeshire Peterborough Camden NHS Camden Central Bedfordshire NHS Bedfordshire Cheshire East NHS Eastern Cheshire; NHS

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South Cheshire

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NHS Vale Royal; NHS West Cheshire West and Chester Cheshire City of London NHS City and Hackney Cornwall NHS Kernow NHS North Durham; NHS Durham Dales, Easington and County Durham Sedgefield Coventry NHS Coventry and Rugby Croydon NHS Croydon Cumbria NHS Cumbria Darlington NHS Darlington Derby NHS Southern Derbyshire NHS Southern Derbyshire; NHS North Derbyshire; NHS Erewash; NHS Tameside and Derbyshire Glossop NHS North, East, West Devon; Devon NHS South Devon and Torbay Doncaster NHS Doncaster Dorset NHS Dorset Dudley NHS Dudley Ealing NHS Ealing NHS East Riding of Yorkshire; East Riding of Yorkshire NHS Vale of York NHS Eastbourne, Hailsham and Seaford; NHS Hastings & Rother; NHS High Weald Lewes East Sussex Havens Enfield NHS Enfield NHS Basildon and Brentwood; NHS Mid Essex; NHS Castle Point, Rayleigh and Rochford; NHS North East Essex; NHS Essex West Essex Gateshead NHS Gateshead

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Gloucestershire NHS Gloucestershire Greenwich NHS Greenwich Hackney NHS City and Hackney Halton NHS Halton Hammersmith and Fulham NHS Hammersmith and Fulham NHS West Hampshire; NHS North Hampshire; NHS South Eastern Hampshire; NHS Fareham and Gosport; NHS North East Hampshire and Hampshire Farnham Haringey NHS Haringey Harrow NHS Harrow NHS Hartlepool and Stockton- Hartlepool on-Tees Havering NHS Havering Herefordshire NHS Herefordshire NHS East and North Hertfordshire; NHS Herts Valleys; NHS Cambridgeshire Hertfordshire and Peterborough Hillingdon NHS Hillingdon Hounslow NHS Hounslow

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7. NHS Health Board (Wales and Scotland)

Reference Table 4: Health Board to local authority for Wales

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Health Board Local Authority Abertawe Bro Morgannwg UHB Swansea; Neath Port Talbot; Bridgend Anueurin Bevan Health Board Caerphilly; Blaenau Gwent; Torfaen; Monmouthshire; Newport Betsi Cadwaladr UHB Isle of Anglesey; Gwynedd; Conwy; Denbighshire; Flintshire; Wrexham Cardiff and Vale UHB The Vale of Glamorgan; Cardiff Cwm Taf Health Board Rhondda Cynon Taf; Merthyr Tydfil Hywel Dda Health Board Ceredigion; Pembrokeshire; Carmarthenshire Powys Teaching Health Board Powys

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Reference Table 5: Health Board to local authority for Scotland Health Board Local Authority NHS Ayrshire and Arran East Ayrshire; North Ayrshire; South Ayrshire NHS Borders Scottish Borders NHS Dumfries and Galloway Dumfries and Galloway NHS Fife Fife NHS Forth Valley Clackmannanshire; Falkirk; Stirling NHS Grampian Aberdeen City; Aberdeenshire; Moray NHS Greater Glasgow and North Lanarkshire; South Clyde Lanarkshire; East Dunbartonshire; East Renfrewshire; Glasgow City; Inverclyde; Renfrewshire; West Dunbartonshire NHS Highland Argyll and Bute; Highland NHS Lanarkshire North Lanarkshire; South Lanarkshire NHS Lothian East Lothian; City of Edinburgh; Midlothian; West Lothian NHS Orkney Orkney Islands NHS Shetland Shetland Islands NHS Tayside Angus; Dundee City; Perth and Kinross NHS Western Isles Eilean Siar

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8. NHS Health and Social Care Trust (Northern Ireland)

Reference Table 6: NHS Health and Social Care Trust to local authority for Northern Ireland Health and Social Care Trust Local Authority Belfast Health and Social Care Belfast; Lisburn and Trust Castlereagh Northern Health and Social Care Antrim and Newtownabbey; Trust Causeway Coast and Glens; Mid and East Antrim; Mid Ulster South Eastern Health and Social Newry, Mourne and Down; Care Trust North Down and Ards; Lisburn and Castlereagh Southern Health and Social Armagh, Banbridge and Care Trust Craigavon; Mid Ulster; Newry, Mourne and Down Western Health and Social Care Derry and Strabane; Fermanagh Trust and Omagh; Causeway Coast and Glens

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9. Hospitals (Northern Ireland)

Reference Table 7: NHS Health and Social Care Trust hospital for Northern Ireland Hospitals with ophthalmology Health and Social Care Trust departments Belfast Health and Social Care Belfast City; Mater Infirmorum; Trust Royal Victoria South Eastern Health and Social Ards; Bangor; Downe; Lagan Care Trust Valley; Ulster Southern Health and Social Armagh Community; Craigavon Care Trust Area; Daisy Hill; South Tyrone Western Health and Social Care Altnagelvin Area; Roe Valley; Trust South West Acute; Tyrone County

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