Survey of Services for Adults with Visual Impairment Living in London

A Vision for London

Survey of services for adults with visual impairment living in London

October 2009

Prepared by Henrietta Doyle and John Harris on behalf of the London Visual Impairment Forum Contents

Acknowledgments...... 3

Executive Summary...... 4

Recommendations...... 9

Introduction...... 10

The survey...... 11

The policy context...... 12

Method...... 13

Respondents...... 16

Timings...... 17

Findings of the Survey...... 18

Overview of all surveyed services...... 52

Other services for people who are visually impaired...... 63

Other initiatives...... 65

Conclusions...... 66

Recommendations...... 67

Recommendation 1...... 67

Meeting the needs of adults who are visually impaired...... 69

Standard services...... 70

Additional services...... 71

A Vision for London: Survey of services for adults with visual impairment living in London 2 Optimum services...... 72

Appendices...... 73

Appendix 1: References...... 73

Appendix 2: Glossary of terms & abbreviations...... 75

Appendix 3: Registration as severely sight impaired & sight impaired...... 77

Appendix 4: Number of blind and partially sighted people registered with councils by age group...... 78

Appendix 5: Resident population: London boroughs by age, 2005:...... 82

Appendix 6: GLA 2008 Ethnic Group Population Projections, (GLA, DMAG Briefing 2009-08 August 2009)...... 84

Appendix 7: Ethnic group populations as proportions of total population, 2001-2031...... 85

Appendix 8: Voluntary groups providing services and activities in London...... 86

Appendix 9: List of services surveyed...... 88

Appendix 10: Questionnaire, short version...... 89

Appendix 11: Questionnaire, long version...... 94

A Vision for London: Survey of services for adults with visual impairment living in London 3 Acknowledgments

We would like to thank Action for Blind People, the RNIB Group, Guide Dogs and Metropolitan Society for the Blind for funding the post of London Visual Impairment Forum’s Development Worker.

Particular thanks go to all the respondents who provided the information for the survey of services. We would also like to thank Hannah Webber for patiently providing advice on data analysis, Gershon Anderson Ward for technical advice and Anna Hudson for considerable administrative support and advice.

A Vision for London: Survey of services for adults with visual impairment living in London 4 Executive Summary

This report presents the findings of a survey of services for adults who are visually impaired in London. It was commissioned by the London Visual Impairment Forum and finalised in September 2009.

This survey was designed to identify the services currently available to visually impaired people and to inform the debate about the kinds of services needed for the future. It focuses on services for people that are registered as sight impaired or severely sight impaired or eligible for registration.

The services surveyed are provided by the NHS, local authority social services and the voluntary sector in each of the 32 London boroughs and the City of London. Twenty four different types of services were surveyed. The survey does not include services provided uniformly on a national basis or services to prevent sight loss.

Most services are provided or funded through local authorities, primary care trusts or the voluntary sector. The findings are presented to highlight the range of services available for people with visually impairment living in each of the 32 boroughs and City of London.

Note: London – includes the 32 boroughs and the City of London. The City of London is classified as a borough in this report, making 33 boroughs.

Voluntary sector organisations are ‘not for profit’ agencies such as charities and community interest groups. The survey did not ask whether charities were registered with the Charity Commission.

The findings are based on the information provided by respondents responsible for providing services in each of the local authority areas included in the survey, between November 2008 and June 2009. Final checks were made to confirm some of the data in September 2009.

A Vision for London: Survey of services for adults with visual impairment living in London 5 1. Ophthalmology departments  There are 36 hospitals with ophthalmology departments  All but 3 boroughs, (Merton, Richmond and Southwark) have a hospital with an ophthalmic department

2. Optometric low vision services  21 boroughs have a low vision service in a hospital ophthalmic department

3. Community low vision services  11 boroughs have a community low vision service offering an assessment from an optometrist and in part from a rehabilitation officer

4. Support and information services in hospital eye clinics  19 boroughs have a service within the borough  Residents in 5 boroughs receive a service based in a neighbouring borough  9 boroughs with ophthalmology departments do not have a service  6 information and support services are provided on more than one day per week  11 are provided on one day or half a day per week

5. Outreach services  14 boroughs have volunteer home visitors/befrienders  13 inner London boroughs have employed home visitors  Volunteers provided by the volunteer bureau are available in Croydon and Newham  Havering, Sutton and Wandsworth have a regular tele-befriending service  The local authority’s sensory team in Barking & Dagenham and Bexley, provide regular drop in sessions in a community setting  Kensington & Chelsea, Merton and Sutton have an outreach service provided by the voluntary sector

6. Rehabilitation services A rehabilitation service is available in all London boroughs. However, the number of rehabilitation officer posts in relation to the number of adults who are visually impaired varies considerably. For example, there is:

A Vision for London: Survey of services for adults with visual impairment living in London 6  1 full-time rehabilitation officer to 1690 adults who are visually impaired in Redbridge  2 full-time rehabilitation officers and 4 part-time rehabilitation officers to 1640 in Croydon  3 full-time rehabilitation officers to 605 registered adults in Richmond.  Harrow, Hounslow, Richmond have ‘early intervention officers’

7. Specialised services for those with learning difficulties  On one day a week a low vision service provides an assessment with an optometrist and rehabilitation officer, for visually impaired Camden and Islington residents with learning difficulties, at the Royal National Institute of Blind People  A customised assessment for people with learning difficulties is available in Merton, Sutton and Tower Hamlets

In residential homes for people with learning difficulties in Bexley the following initiatives are in place:  Questionnaires are sent to all people with learning difficulties in residential homes asking when they last had an eye check and to offer one if necessary  Awareness training for carers in residential homes about sight loss.  Information provided for residents to increase understanding of the process needed to have an eye test

8. Emotional support  Emotional support is available in all boroughs, provided by rehabilitation officers and staff from voluntary organisations  Support is also provided by other people who are visually impaired during peer support meetings and recreational activities  3 boroughs, Camden, Islington and Croydon have a qualified counsellor. In Camden and Islington it is only available to those that use the low vision service provided at the premises of Royal National Institute of Blind People (RNIB), in Judd Street

9. Employment support  Employment support is offered to all London residents

10. IT training  Specialised IT training is available in all but 6 boroughs

A Vision for London: Survey of services for adults with visual impairment living in London 7 11. Braille training  Braille training is offered in 20 boroughs

12. Links to further education  Links to further education colleges are available in 17 boroughs

13. Resource centres and assistive technology support services  Assistive technology advice is offered to all London residents by a national voluntary organisation  12 boroughs have a local resource centre  There is one regional resource centre in the borough of Camden

14. Welfare benefits support  17 boroughs have a local staff member to provide support to visually impaired people applying for welfare benefits

15. Concessions  30 out 33 boroughs have one-to-one support to apply for concessions such as a freedom pass

16. Housing repairs/issues  Support with housing repairs/issues is available in 18 boroughs

17. Reading correspondence  Support reading correspondence is available in all boroughs apart from Havering, Newham and Redbridge

18. Social activities  Provision varies from borough to borough for example; 1 borough provides 12 social activities, 10 boroughs have 2, 9 boroughs provide 1, while 4 boroughs do not provide any

19. Leisure activities  Provision differs from borough to borough for example; 3 boroughs have 6 activities, 7 boroughs have 1 activity, yet 15 boroughs do not have any

A Vision for London: Survey of services for adults with visual impairment living in London 8 20. Physical or sporting activities  Provision differs from borough to borough for example; 1 borough provides 8 different forms of exercise, 7 boroughs provide 2 physical activities, while 13 boroughs do not have any

21. Talking newspapers  All but 4 boroughs have a local talking newspaper. The boroughs without one are Camden, the City of London, Hammersmith & Fulham and Southwark

22. Directories of services/information leaflets  19 boroughs provide information on services specifically for visually impaired people

23. General information on services  Available in all boroughs from rehabilitation officers and voluntary sector staff in addition to the staff already mentioned, such as home visitors and information & support staff at hospital ophthalmic departments

24. Specialised housing for people with visual impairment  Six boroughs have accommodation specifically for adults who are visually impaired, with staff available to provided assistance if needed. The boroughs are Barnet, Brent, Hammersmith & Fulham, Redbridge, Southwark and Wandsworth  In Barnet there is housing for those that are working, provided by a housing association, and housing for Jewish people provided by a voluntary organisation  In Brent and Redbridge there is housing for Jewish people only  In Hammersmith & Fulham is mainly for those of working age

25. Low vision service committees  19 boroughs have a low vision service committee or a similar group

A Vision for London: Survey of services for adults with visual impairment living in London 9 Recommendations Recommendation 1: We recommend commissioners in each borough adopt the findings set out in this report, or alternatively, conduct an audit of current service provision, and then set targets for the development of services to meet the needs of visually impaired people.

Recommendation 2: We recommend that each borough reviews the effectiveness of its low vision service committee (LVSC) (or equivalent) and takes steps to ensure representation from commissioners, lead officers with responsibility for sensory impairment and representatives from voluntary sector agencies.

Recommendation 3: We propose that each LVSC is made responsible for the delivery of improved services.

Recommendation 4: We propose that each LVSC is invited to issue an annual report that sets out its proposals for developing services to meet the needs of visually impaired people and that these reports are shared with other LVSCs

Recommendation 5: We also recommend that all boroughs attend the London wide low vision services committee meetings being organised under the auspices of Vision 2020.

A Vision for London: Survey of services for adults with visual impairment living in London 10 Introduction

Permanent vision loss is a traumatic event that frequently has profound and long term effects on a person’s life style, relationships, health and psychological wellbeing. It affects every area of life from reading a newspaper or a letter, to getting about on foot or using public transport; from participation in leisure activities to employment; from playing sport to meeting people and making friends. Because the incidence of sight loss is strongly age-related the majority of people are affected at a time in their lives when they are already having to adjust to other major changes including retirement, declining health and other acquired disabilities, such as hearing loss and mobility difficulties. Consequently, visual impairment is often associated with a cycle of low self-esteem, declining confidence, loss of independence and increasing social isolation. There is a considerable range of services that are designed to help people make a positive adjustment to permanent sight loss and thus prevent these adverse outcomes. However, little is known about the number of services available or the extent to which service provision varies from one geographical area to another.

Services for visually impaired people have evolved over many years and reflect social, scientific, medical and cultural developments in society. The charitable and benevolent agencies of the 19th and early 20th centuries were enhanced in the second half of the 20th Century by the introduction of the welfare state and the enhanced role of the local authority in providing a wide range of welfare and support services for disabled people, including those registered as blind or partially sighted. At the same time, the advances in medical science and a huge post-war investment in the National Health Service resulted in better treatment for many eye conditions and the provision of ‘free’ prescriptions for corrective lenses. A national screening programme in schools detected sight problems among children and offered a range of interventions including prescription glasses, medical treatment and special education. In the latter half of the 20th Century, increases in disposable income and the emergence of the ‘fashion industry’ created a new and more lucrative niche for the dispensing optician

A Vision for London: Survey of services for adults with visual impairment living in London 11 whose customers are as a much concerned with how others see them as they are with their ability to see other people.

Anyone who looses their sight is faced with a perplexing patchwork of services. They include those funded by government and delivered as a statutory entitlement and those provided at the discretion of local societies and funded from voluntary income. Following assessment and treatment by medical staff, anyone with permanent sight loss is likely to be offered advice from several different professional groups including optometrists, orthoptists, social workers, rehabilitation officers, voluntary sector staff, welfare rights advisors, to name but a few. Some services are offered within the boundaries of a local authority, others within the ambit of a primary care trust and yet others on a national or regional basis. It is not surprising that ordinary people who lose their sight are often confused and disheartened by the complexity of ‘the system’. Nor is it surprising that people report considerable differences in their experience of service provision.

This report presents the findings of a survey of services for adults with visual impairment who are resident in Greater London. It was commissioned by London Visual Impairment Forum and completed in September 2009.

The survey

The survey covers services specifically for adults who are visually impaired provided by the National Health Service, local authorities and voluntary sector agencies. It includes services that are based in single boroughs, those that span several boroughs and those that embrace all 32 boroughs and the City of London. It does not, however, include services provided uniformly on a national basis such as the Royal National Institute for Blind People’s helpline or the Guide Dogs for the Blind Association’s provision of guide dogs, because these services are offered to all residents across the country.

A Vision for London: Survey of services for adults with visual impairment living in London 12 The majority of the information was gathered between November 2008 and June 2009, using questionnaires, interviews, telephone and email contact to obtain information from managers and staff responsible for delivering services. The information was finalised in September 2009.

The term ‘visual impairment’ is used to describe an eye condition resulting in registration as sight impaired (partially sighted) or severely sight impaired, (blind) or that renders the person eligible for registration. There are over 39,000 people registered as sight impaired or severely sight impaired in Greater London, the majority of whom are over 75 years. There are also many people living with permanent sight loss who are not registered (Ref.1, 2 & 3, appendix 3 & 4).

The policy context

The huge public expenditure on health and social care services has meant that they have received a considerable amount of attention from central government. Over the last decade, considerable efforts have been made to set, monitor and raise the standards of health and social care by creating National Service Frameworks (for example, for older people) enhancing the regulatory framework (the Care Quality Commission) and setting up new advisory bodies such as the Social Care Institute for Excellence (SCIE).

There has been increased attention to the experience of service users, resulting in systematic efforts to improve partnership working between the NHS and those responsible for local authority services, increased opportunities for service users to be represented in forums that determine local policies and recognition that services are most effective when they are based within the local community.

Efforts to increase the extent to which service users feel that they are in control and able to exercise choice regarding the services they receive is leading to the introduction of self directed care and individually allocated budgets, based on an assessment of need, that can be used to purchase treatment or support at patient’s/service user’s discretion.

A Vision for London: Survey of services for adults with visual impairment living in London 13 In the interests of restricting the burgeoning cost of health and welfare services, there is a renewed interest in early intervention and other measures designed to prevent, delay or ameliorate ill health and disabling conditions and to promote independent living for as long as possible.

The UK Vision Strategy, launched in April 2008, was based on a national consultation exercise, led by the voluntary sector, that included service users, professionals responsible for delivering health and social care, voluntary sector organisations and representatives from industrial and commercial providers (Ref.3).

The strategy was developed in response to the World Health Assembly VISION 2020 resolution to reduce avoidable blindness by the year 2020 and improve support and services for blind and partially sighted people. The strategy aims to:  Improve the eye health of the people in the UK  Eliminate avoidable sight loss and deliver excellent support for people with sight loss  Promote inclusion, participation and independence for people with sight loss.

The translation of policy into practice is seldom straightforward and for those responsible for shaping services for visually impaired people, London represents a particular set of challenges. For example, the administrative boundaries for local authorities and Primary Care Trusts (PCTs) often do not coincide, there are very high levels of deprivation, enormous ethnic diversity and surprisingly little information regarding either the range of services currently available or the kind of services that will be needed in the future. This survey was designed to identify the services currently available to visually impaired people and to inform the debate about the kinds of services needed for the future.

Method

The survey covers services specifically for adults who are visually impaired in the 32 London boroughs and the City of London. The survey of services

A Vision for London: Survey of services for adults with visual impairment living in London 14 for adults is the first instalment of the survey. A second document, surveying the provision for visually impaired children is planned.

The 32 London boroughs are as follows, Barking & Dagenham, Barnet, Bexley, Brent, Bromley, Camden, Croydon, Ealing, Enfield, Greenwich, Hackney, Hammersmith & Fulham, Haringey, Harrow, Havering, Hillingdon, Hounslow, Islington, Kensington & Chelsea, Kingston, Lambeth, Lewisham, Merton, Newham, Redbridge, Richmond, Southwark, Sutton, Tower Hamlets, Waltham Forest, Wandsworth and Westminster.

In this report the City of London has been counted as a borough, making 33 ‘boroughs’. However, the City has only 15 adults registered as blind or partially sighted and this needs to be taken into consideration when looking at the Findings of the survey. The numbers of registered people and the population of each borough are provided in the Appendices 3, 4, 4b, 5, 6 & 7 of this report.

The following services were included in the survey:

Services provided in hospital eye clinics  The existence of hospital ophthalmology departments.  Optometric low vision services in hospital eye clinics.  Information and support services for patients in eye clinics were also surveyed. This service is provided either by the voluntary sector or social service rehabilitation officers.

Rehabilitation services funded by local authorities  The number of full-time, part-time and assistant rehabilitation officer posts for adults who are visually impaired, funded by local authority social services, was surveyed.

Voluntary sector services for adults who are visually impaired, these included:  Pan London services  Services that cover more than one borough  Specific borough services

A Vision for London: Survey of services for adults with visual impairment living in London 15 Small user groups, sometimes covering part of a borough, have not been comprehensively mapped, due to time constraints.

Generally the report comments on whether services are provided by statutory or voluntary sector. (The names of the voluntary organisations are listed in Appendix 8).

In all, 24 different types of services were surveyed, (see full list in the Appendix 9) as well as low vision service committees that were holding regular meetings at the time of the survey.

In the course of collecting the information it became clear that the list of services included in the questionnaire was incomplete and ‘new’ services were identified when the process of data collection was well underway. In retrospect some of these services should have been included in the questionnaire, for example regular events for newly registered people.

Other initiatives Information about initiatives, that can improve the quality of life of adults who are visually impaired, which are not direct services, was also collected. This included:  Visual awareness training for professionals, school children and others  Access audits of buildings providing services  Raising awareness of visual impaired people’s needs through consultations and campaigns.

These are listed in the ‘Other Initiatives’ section, however, they were not comprehensively surveyed.

Due to time constraints it was not possible to collect information on:  The number of people receiving each service  The quality of each service, i.e. whether service users were satisfied with a service or not.  Optometric low vision services funded by Primary Care Trusts, (PCT), provided in community settings, and optometric domiciliary

A Vision for London: Survey of services for adults with visual impairment living in London 16 services. Some information about these services was obtained and is noted under ‘Other Services’.

Pilot projects were also not surveyed, for example new initiatives such the hospital information and support services for residents in Barking & Dagenham and the various pilot projects established as part of the Tower Hamlet’s Eye Health Strategy have not been included.

The survey is particularly concerned with variations across London and the extent to which service users resident in one part of the Capital are better or worse off, in terms of service provision, than those in another. Given the resources available and the time scale for completion, it was necessary to restrict the scope of the survey to services specifically for adults who are visually impaired provided either on a London-wide basis or at local borough level. It does not include services provided uniformly on a national basis or services provided by the commercial sector, for example high street opticians or retail outlets for aids and equipment. Nor does it attempt to examine the number of people using any particular service or the quality of similar services operating in relatively close proximity.

Respondents

Respondents were contacted through a variety of means, the details are as follows:

Sensory teams The managers of the social service sensory teams in all London boroughs were contacted through the manager’s network, with a request to fill in a short questionnaire (see Appendix 10).

Face-to-face meetings were held with the managers or rehabilitation officers from 12 sensory teams and with the managers of three voluntary groups in London, which hold the contract for rehabilitation services. Other managers or rehabilitation officers provided information via telephone and

A Vision for London: Survey of services for adults with visual impairment living in London 17 email. Only limited information on services in Redbridge was obtained due to staff being on sick leave.

Voluntary organisations: Face-to-face interviews were held with the managers of the majority of local borough based voluntary groups that are large enough to employ at least one member of staff.

Staff with overall responsibility for service provision were interviewed and where possible, additional information was obtained from staff managing services within a single borough.

A longer questionnaire was used for all face-to-face interviews, (see Appendix 10). A small amount of information was also obtained via the web.

Timings

The survey was started in November 2008, interviews were completed by the second week in April, and further information was received by June 2009. All those who responded were provided with a summary of the information obtained and invited to check the data. Any inconsistencies were addressed and final checks completed in September 2009.

Note: All but one table in the body of the report has been described in words to try and ensure accessibility to visually impaired people. However, the tables in the appendixes were obtained from various sources and it has not been possible to describe these in words.

A Vision for London: Survey of services for adults with visual impairment living in London 18 Findings of the Survey

Perhaps the most remarkable aspect of services available to people with a visual impairment is their heterogeneity; they differ with respect to their area of operation, the funding arrangements, the professional background of staff employed, their size, their legal status and, not least, their purpose.

For this reason it has not been easy to establish a single organising framework for the presentation of the findings. Hospital based services are considered first, as these are often the services that people encounter at the start of their eye-care journey, these include:

1. Ophthalmology departments 2. Optometric low vision services 3. Community low vision services 4. Information & support services in hospital eye clinics

The data on the following services is then provided: 5. Outreach services 6. Rehabilitation services 7. Specialised services for those with learning difficulties 8. Emotional support

The findings under the headings of 9. Employment support 10. IT training 11. Braille training 12. Links to further education 13. Resource centre and assistive technology support services are shown next followed by the data on one-to-one support available to obtain:

14. Welfare benefits support 15. Concessions 16. Housing repairs/issues 17. Reading correspondence

A Vision for London: Survey of services for adults with visual impairment living in London 19 The findings in relation to leisure activities come next: 18. Social activities 19. Leisure activities 20. Physical or sporting activities

And then the data on different kinds of information: 21. Talking newspapers 22. Directories of services/information leaflets 23. General information on services

Lastly the data on the following is presented: 24. Specialised housing for people with visual impairment 25. Low vision service committees

A Vision for London: Survey of services for adults with visual impairment living in London 20 1. Ophthalmology departments

A referral from a GP is needed before a patient can receive services from a hospital eye clinic. All London hospitals serve more than one borough, for instance, the eye clinic at Whittington Hospital receives patients that live in Camden, Islington, Haringey and further afield too. Moorfields Eye Hospital has a wide range of services and is internationally renowned, so patients travel from abroad as well as from across the UK and London.

Eye clinics provide consultant ophthalmology services for the diagnosis and treatment of eye conditions. The conditions treated in each ophthalmic department reflect the expertise of the consultants concerned. However, the range of services provided was not surveyed.

Certificate of registration If treatment is not possible, and a patient’s low vision is permanent, the ophthalmic consultant can complete a ‘Certificate of Visual Impairment’ (CVI), which confirms the patient’s eligibility for registration as ‘sight impaired’ (partially sighted) or ‘severely sight impaired’ (blind). The local social services will formally register the patient. However, it is the patient’s choice whether to go ahead with registration or not.

Once social services have received the CVI from the hospital, the person may be offered rehabilitation services, usually provided by the borough’s sensory team. Registration is used as an eligibility criterion for many services and for others it increases the likelihood that an application will succeed. Patients are not always aware of the benefits of registration and need to be provided with this information.

Findings The data showed shows that there are:  36 hospitals in London have an ophthalmology department  30 boroughs have one or more hospital with an ophthalmology departments  24 boroughs have one hospital with an ophthalmology department

A Vision for London: Survey of services for adults with visual impairment living in London 21  6 boroughs have two hospitals, each with an ophthalmology department. These boroughs are Barnet, Camden, Hillingdon, Islington, Lambeth and Tower Hamlets  Merton, Richmond and Southwark do not have a hospital with an ophthalmology department

2. Optometric low vision services

Consultants can refer patients to optometric low vision services. The optometrists providing this service aim to enable patients to make the best use of their remaining vision. Patients receive a thorough eye test, followed by advice and training to use low vision aids such as magnifiers. These are usually provided free on long term loan to those who are registered or are eligible for registration.

The availability of optometric low vision services attached to the ophthalmic department in local hospitals were surveyed. However, the frequency with which the service was offered was not.

Findings The data shows the following:  Of the 36 hospitals with an ophthalmic department, 24 have a low vision service attached.  21 boroughs have a low vision service situated in a local hospital’s ophthalmic department  3 boroughs had 2 local hospital’s each with a low vision service situated in the ophthalmic department

The hospitals with low vision services within the ophthalmology department are as follows (the borough in which the hospital is located is shown in brackets):

Edgware Community Hospital (Barnet), Queen Mary (Bexley), Central Middlesex Hospital, (Brent), Royal Free Hospital and University College Hospital, (Camden), St Bartholomew’s Hospital (City of London), Mayday University Hospital, (Croydon), Ealing Hospital, (Ealing) North Middlesex Hospital, (Enfield), Charing Cross Hospital (Hammersmith and Fulham),

A Vision for London: Survey of services for adults with visual impairment living in London 22 Northwick Park Hospital, (Harrow), Queens Hospital, (Havering), Hillingdon and Mount Vernon Hospitals, (Hillingdon) Royal Eye Unit, Kingston Hospital, (Kingston), St Thomas’s and Kings College Hospital, (Lambeth), King Georges, (Redbridge), Roy Harfitt Eye Unit, Sutton Hospital, (Sutton) Royal London Hospital (Tower Hamlets), Whipps Cross, (Waltham Forest), St Georges Hospital, (Wandsworth).

Moorfields Eye Hospital, in the borough of Islington and the Western Eye Hospital, in the borough of Westminster both have low vision services.

The hospitals with ophthalmology departments, which do not have a low vision services are: Barking Hospital (Barking & Dagenham) West Kent Eye Centre, Princess Royal, (Bromley), Queen Elizabeth (Greenwich), Homerton, (Hackney), St Ann’s (Haringey), West Middlesex, (Hounslow), Chelsea & Westminster Hospital, (Kensington & Chelsea), Lewisham Hospital (Lewisham) Newham University Hospital, (Newham), Bromley residents have a low vision service held at Kent Association for the Blind’s resource centre in Bromley and Merton residents have a service at Merton Vision’s resource centre. Both services are funded by the PCT.

It was found that there are optometric low vision services in a community setting in Enfield, Haringey and Waltham Forest. Also optometric domiciliary low vision services are available in 5 boroughs as follows: Barnet, Islington, Kensington & Chelsea, Lewisham and Newham. Because optometric low vision services were not included in the questionnaire, it is quite possible the similar services exist in other boroughs.

3. Community low vision services

Community low vision services provide an assessment carried out by an optometrist and a rehabilitation officer and in some instances voluntary sector staff, outside the usual hospital setting at a venue that is designed to be easily accessible to service users. The optometrist and rehabilitation officers can provide low vision aids on loan when appropriate. The services

A Vision for London: Survey of services for adults with visual impairment living in London 23 are free at the point of delivery and are often provided at a voluntary group’s premises. Services were grouped on the basis of the frequency:  Weekly  Monthly  Less than monthly

Findings The data showed there are 8 community low vision services in London:  A weekly service is available for residents of Bromley, Camden, Havering and Islington  A monthly services is available in Barking & Dagenham, Merton, Sutton and Wandsworth

In the light of the information provided in respect of low vision services in both hospital and community settings, it is apparent that the following boroughs do not offer a local a low vision service within their borough: Greenwich, Southwark and Hackney. This information needs to be treated with care because not all optometric services in community settings were surveyed.

4. Information & support services in hospital eye clinics

The service provides an important bridge between the hospital and services available in the community. All services that involve employed staff provide a follow-up service to ensure the patient has the services, benefits and concessions needed once the patient has returned home. These services offer:  Advice about certification and registration  Information on eye conditions  Emotional support  Assistive technology advice  Referral to other agencies

Each aspect of the service is described briefly below:

Advice about certification and registration

A Vision for London: Survey of services for adults with visual impairment living in London 24 A range of services, benefits and concessions are available to those with permanent vision loss. These can vary from a Transport for London freedom pass, membership of Dial-a-Ride, or subsidised taxi fares to welfare benefits such as Disability Living Allowance and free directory enquiries. Unless the benefits of registration are clearly described, patients may not be willing to complete the registration process.

Information on eye conditions While hospital staff are usually the best equipped to provide information on eye conditions, patients are not always able to absorb the information during the consultation, particularly if they are shocked by the news that their visual impairment cannot be treated. Information provided by another member of staff or in accessible formats to take home can be useful.

Assistive technology advice Assistive technology designed specifically for visually impaired people can increase the level of independence. The equipment varies from simple items such as a liquid level indicator to CCTV (video magnifiers) or computers with audio programmes.

Referral to other agencies There are many organisations providing services for adults who are visually impaired in London, however, information can be difficult to obtain once patients return to the community. In addition, an application form may need to be completed, which can act as a barrier for visually impaired people.

Emotional support Emotional support is needed because vision loss can be traumatic as independence, activities and sometimes employment is affected.

Several models of delivering hospital eye clinic information and support services were identified in the survey:  Social services rehabilitation officers provide the service once a week. Sometimes neighbouring boroughs provide officers in rotation  Employed advisors, for example eye care liaison officers (ECLOs), employed by the RNIB  Volunteers supported by a voluntary organisation’s staff member

A Vision for London: Survey of services for adults with visual impairment living in London 25 Findings The survey indicated that:  Out of the 36 London hospitals with consultant ophthalmology services, 22 offer an information & support service  19 boroughs have a local hospital with an information and support services situated in the ophthalmology department  3 boroughs have 2 hospitals with ophthalmic department, each offering an information & support service  14 boroughs do not have any information & support service in a local hospital

Some boroughs provide a service for their residents in a hospital in a neighbouring borough, for instance:  Southwark and Lewisham provide a service for their residents in the ophthalmic department at Kings College Hospital, in Lambeth  Haringey at Whittington Hospital, in Islington or at North Middlesex Hospital in Enfield  Merton at St George’s, Wandsworth  Richmond at the Royal Eye Unit, Kingston Hospital

Hospitals without an information & support service offered in their ophthalmic departments are as follows: Moorfields at Barking Hospital, (Barking & Dagenham), Queen Mary’s (Bexley), West Kent Eye Centre, Princess Royal University Hospital, (Bromley), St Bartholomew’s (City of London), Queen Elizabeth, (Greenwich), Moorfields at Homerton, (Hackney), Charing Cross Hospital, (Hammersmith & Fulham), Northwick Park Hospital, (Harrow), Moorfields, (Islington), Chelsea & Westminster Hospital, (Kensington & Chelsea), Newham University Hospital, King George’s (Redbridge), Royal London Hospital, (Tower Hamlets) Whipps Cross, (Waltham Forest), Western Eye Hospital, (Westminster).

Note: A service is planned to start shortly at Charing Cross Hospital, (Hammersmith & Fulham. At Northwick Park Hospital, (Harrow) and in the Western Eye Hospital, (Westminster) information leaflets are provided. It was not possible to ascertain if volunteers were providing advice and support at the Western Eye Hospital.

A Vision for London: Survey of services for adults with visual impairment living in London 26 The services are divided into 3 categories, see below:  The service is provided more than one day a week, by employed staff and/or volunteers supported by employed staff  The service is provided on one day a week, by employed staff and/or volunteers supported by employed staff  The service is provided by hospital volunteers

Services vary in the extent to which they are integrated into the eye clinic. For instance, in a few boroughs information and support staff are given access to the patient records and the certificate of registration and hospital staff regularly make referrals. Although this information was provided about the services in some hospitals, it was not collected systematically for all services and therefore is not included in the findings presented below.

Ophthalmology departments provide a varying number of eye clinics during a week and some of these benefit from an information and advice service. It is likely that there are many clinics are without an information & support service. This is particularly relevant for Moorfields hospital, where many clinics are held during a week.

The number of hospital ophthalmic departments which host an information and support services in one or more eye clinics is shown below:

Findings Information and support services are provided on more than one day a week in the following 5 hospitals: Moorfields at Ealing Hospital (Ealing), Queens Hospital (Havering), St Thomas’s (Lambeth), Roy Harfitt Eye Unit, Sutton Hospital (Sutton) and St George’s (Wandsworth, also services Merton’s residents).

The following 11 hospitals have a one day or half a day information support service: Barnet General and Edgware Hospital, (Barnet), Central Middlesex, (Brent), Mayday University Hospital, (Croydon), North Middlesex Hospital, (Enfield and Haringey residents), Hillingdon & Mount Vernon

A Vision for London: Survey of services for adults with visual impairment living in London 27 Hospitals, (Hillingdon) West Middlesex Hospital, (Hounslow), Whittington Hospital (Islington serves Haringey residents) Kingston Hospital, (Kingston and Richmond residents), King’s Hospital (Lambeth, Lewisham and Southwark residents).

Volunteers from the Royal Free Hospital, in the borough of Camden, provide a service in the ophthalmology department.

5. Outreach services

Outreach services offer regular contact with visually impaired people who live alone or are otherwise isolated and find it difficult to access services.

Four types of outreach services were identified i. Tele befriending ii. Outreach by rehabilitation officers iii. Home visiting/befriending iv. Outreach officers provided by a voluntary organisation

i. Tele-befriending Tele-befriending services are designed to maintain regular social contact with visually impaired people and to ensure referrals to other services are made if need be. Contact is usually on a weekly basis and provided by the voluntary sector.

ii. Outreach by rehabilitation officers In some boroughs rehabilitation officers from social services sensory teams provide a “drop-in” outreach service in the local library or civic offices. iii. Home visiting/ befriending There are three different types of services within this category, all provided by the voluntary sector:  Employed home visitors: Home visitors are employed by a voluntary organisation for people who are visually impaired. The service is provided to those that are isolated and want more social contact

A Vision for London: Survey of services for adults with visual impairment living in London 28 Companionship, reading of correspondence and information about services, benefits, concessions and activities is provided. The service will facilitate initial contact with another service, if need be.  Employed assessor with volunteers: An initial assessment is carried out by an employee of a voluntary organisation for visually impaired people. The service user is then allocated to a volunteer home visitor The home visitor/befriender provides companionship, reads correspondence and sometimes escorts the service user to appointments and will take on small tasks or handyman jobs  The volunteers are provided by local volunteer bureau: Volunteers receive visual awareness training from the local authority’s sensory team or the local voluntary group iv. Voluntary sector outreach officers In Kensington & Chelsea the voluntary sector employs an outreach officer who provides a similar service to the home visitors, as well as support to apply for welfare benefits, the facilitation of a monthly social group and day trips. In Merton an outreach officer provides a service to the black and minority ethnic (BME) community in the borough.

Findings  17 boroughs have volunteer home visitors/befrienders.The boroughs are as follows: Barnet, Bexley, Brent, Bromley, Ealing, Enfield, Greenwich, Hammersmith & Fulham, Harrow, Hillingdon, Hounslow, Kingston, Merton, Newham, Richmond, Sutton and Wandsworth  13 inner London boroughs have employed home visitors  The boroughs are as follows: Camden, City of London, Greenwich, Hackney, Hammersmith & Fulham, Islington, Kensington & Chelsea, Lambeth, Lewisham, Southwark, Tower Hamlets, Wandsworth and Westminster. An additional home visitor in Tower Hamlets, provides a service to the Bengali community  Volunteers provided by the volunteer bureau are available in Croydon and Newham  3 boroughs have a regular tele-befriending service (Havering, Sutton and Wandsworth)  2 boroughs have an outreach service provided by the local authority’s sensory team (Barking & Dagenham and Bexley)  3 boroughs have an outreach service provided by the voluntary sector, (Kensington & Chelsea, Merton and Sutton)

A Vision for London: Survey of services for adults with visual impairment living in London 29 6. Rehabilitation services Sensory teams provide rehabilitation services for visually impaired people, including those that are registered as sight impaired (partially sighted) or severely sight impaired (blind) and those that are eligible for registration. These services are usually provided by the local authority’s social services. However, in 3 boroughs the local voluntary organisation provides the service under contract to the local authority.

The service provides:  Assessment of the impact of visual impairment on the person’s daily living skills and communication  Training in orientation and mobility  The provision of specialist equipment to aid independence, which has been identified from an assessment  Emotional support  Welfare rights advice  Specialist education advice  Supported employment advice  Advice in all aspects of registration

The number of full-time, part-time and assistant rehabilitation posts were surveyed. However, no information was collected on the number of hours the part-time and assistant rehabilitation officers worked.

Findings The service is provided in all boroughs. However, the number of staff varies considerably from borough to borough. For example there are 1690 adults who are visually impaired to 1 rehabilitation officer in 1 borough and 1640 adults to 2 full-time and 4 part-time officers in another borough. A borough with 605 registered adults has 3 full-time officers.

The table below shows the number of registered adults in each borough and the number of full-time, part-time and assistant rehabilitation officers.

This information is repeated in the form of histograms on pages 32 and 33.

A Vision for London: Survey of services for adults with visual impairment living in London 30 Other staff are employed by the PCTs or local authorities’ social services in additional to rehabilitation officers or hospital eye clinic staff already mentioned. The posts and boroughs are as follows:  VI Services Development Officer, Islington social services  Development Worker, Lambeth  Programme Manager for Low Vision & Eye Care Services, Tower Hamlets

These additional posts were not comprehensively surveyed and there may be similar posts in other boroughs.

Three boroughs, Harrow, Hounslow, Richmond, have ‘Early Intervention Officers’, whose role is to ensure that newly registered clients are visited promptly and assessed for their visual impairment needs, prior to referral for rehabilitation or other statutory services departments.

A Vision for London: Survey of services for adults with visual impairment living in London 31 Table 1: Number of adults registered and availability of rehabilitation officer in each borough

Total Number Fulltime Part-time Assistant Adults Registered Rehab. Officers Rehab. Officers Rehab. Officers

Inner London

Camden 1285 2 0 0 Greenwich 1030 3 0 0 Hackney 975 4 0 0 Ham. & Fulham 810 1 0 0 Islington 1245 2 1 0 Ken. & Chelsea 810 2 0 0 Lambeth 980 1 0 0 Lewisham 1070 3 1 0 Southwark 1215 2 0 0 Tower Hamlets 790 3 0 0 Wandsworth 1375 2 0 0 Westminster 1345 2 0 0 City of London 15 1 0 0

Outer London

Barking & Dag. 695 2 0 0 Barnet 1775 2 0 2 Bexley 810 1 2 1.5 Brent 2260 3 0 0

A Vision for London: Survey of services for adults with visual impairment living in London 32 Bromley 1915 3 1 0 Croydon 1640 2 4 0 Ealing 1590 2 0 .5 Enfield 990 2 1 0 Haringey 1565 2 0 0 Harrow 1115 1 1 0 Havering 855 1 0 2 Hillingdon 1315 4 0 0 Hounslow 1365 2 0 0 Kingston 570 1 1 0 Merton 1090 1 0 1 Newham 1510 2 1 0 Redbridge 1690 1 0 0 Richmond 605 3 0 0 Sutton 1080 2 1 0 Waltham Forest 450 1 0 0

This information is also provided in Fig.1 and Fig.2 on pages 32 and 33.

A Vision for London: Survey of services for adults with visual impairment living in London 33 Fig.1: Number of full-time, part-time and assistant rehabilitation officers in each borough

A Vision for London: Survey of services for adults with visual impairment living in London 34 Fig.2: Number of registered adults to one full-time rehabilitation officer in each of the 33 boroughs

A Vision for London: Survey of services for adults with visual impairment living in London 35 7. Specialised services for those with learning difficulties

Government policy and legislation promotes equal access to services. Discrimination on the grounds of race, gender, age or disability is illegal. Fair and equitable access for all members of society to eye health, eye care and sight loss services is a core value of the UK Vision Strategy. Yet it is generally acknowledged that certain groups have particular difficulty in accessing appropriate services. This includes eye testing services, hospital treatment as well as services for people with a permanent visual impairment. These groups include older people, people from the BME communities and those with learning difficulties.

In some boroughs special initiatives are addressing these issues, for example by setting up services to detect low vision amongst people with learning difficulties.

It was only possible to gather information regarding the services for people with learning difficulties due to time constraints.

Findings The findings of the survey showed that the following services are provided by a partnership between the voluntary, health and social sectors:  A weekly low vision assessment by an optometrist and rehabilitation officer for visually impaired Camden and Islington residents with learning difficulties  A customised assessment for people with learning difficulties is available in Merton, Sutton and Tower Hamlets

In residential homes for people with learning difficulties in Bexley the following initiatives are in place:  Questionnaires are sent to all people with learning difficulties in residential homes asking when they last had an eye check and to offer one if necessary  Awareness training for carers in residential homes about sight loss  Information provided for residents to increase understanding of the process needed to have an eye test Older people

A Vision for London: Survey of services for adults with visual impairment living in London 36 Tower Hamlets has an initiative to obtain information about the frequency of an eye tests for older people. This area of work was not surveyed and there may be other projects in London.

BME community An outreach worker is employed in Merton to provide a service to BME community. These services were not surveyed across London and other services for the BME community may be available.

8. Emotional support

Loss of sight is traumatic as it impacts on all areas of life from reading a bank statement to leisure activities and even employment. The need for emotional support is now becoming recognised and is one of the priority outcomes in the UK Vision Strategy.

Findings The survey showed that informal emotional support is provided in all boroughs by rehabilitation officers or staff from voluntary organisations. Support is also provided by other visually impaired people through peer support groups and as part of social and recreational activities.

In addition three boroughs, Camden, Islington and Croydon have a qualified counsellor. In Camden and Islington it is only available to those that use the low vision service provided at the premises of RNIB in Judd Street.

9. Employment support

Support to create a CV, look for work, interview preparation and work placements can all increase the likelihood of people with visual impairment finding employment. Two voluntary sector organisations provide this support to visually impaired people across all the London boroughs. The service is tailored to the needs of the individual with both one-to-one

A Vision for London: Survey of services for adults with visual impairment living in London 37 support and workshops provided. Both organisations provide support with housing issues and welfare benefits and IT training for those using the employment service.

Assistive technology, such as large screen magnifiers, CCTVs and computers with accessible programmes can enable visually impaired people to maintain employment or take on a new post. Assistive technology is available on loan when people begin employment.

10. IT training

Specialised audio IT programmes and training enable visually impaired people to access IT computer facilities such as the internet, email and Microsoft Office.

Training is provided either by the local voluntary group or at the local further education colleges. Some further education tutors hold regular classes at the local voluntary group’s premises.

Findings Regular classes that provided training were surveyed. All but 6 boroughs have regular IT computer training courses specifically for visually impaired people, on computers with accessible programmes. In Bromley training is given as and when requested. The boroughs that do not have training are Barking & Dagenham, City of London, Greenwich, Hammersmith & Fulham, Redbridge and Sutton.

11. Braille training

Braille, at a basic level, can help visually impaired people to identify items in the kitchen or elsewhere. At a more advanced level, correspondence can be read or produced and reading can be undertaken for pleasure.

A Vision for London: Survey of services for adults with visual impairment living in London 38 Regular classes and one-to-one training in Braille was surveyed. Training is provided by staff from sensory teams, local voluntary organisations or by the local further education college.

Findings Braille training is offered in the following boroughs: Barnet, Bexley, Bromley, City of London, Croydon, Ealing, Enfield, Hackney, Haringey, Hillingdon, Hounslow, Kensington & Chelsea, Kingston, Lambeth, Lewisham, Richmond, Southwark, Sutton, Tower Hamlets and Waltham Forest.

12. Links to further education (FE)

A personal contact in an FE college, usually the disability advisor, who ensures that activities and courses are accessible, can increase the likelihood of person with visual impairment being able to participate in courses provided in mainstream further education.

The survey identified whether or not such a person was known to members of the sensory team or voluntary sector staff.

Findings The following 17 boroughs reported the existence of this kind of support: Brent, Bromley, Camden, Croydon, Hackney, Hammersmith & Fulham, Havering, Islington, Kensington & Chelsea, Kingston, Lewisham, Merton, Newham, Richmond, Southwark, Wandsworth and Westminster.

In the further education college in Southwark, there is a dedicated Support Coordinator specifically for visually impaired students to ensure they can access all courses.

13. Resource centres or assistive technology support and advice

A Vision for London: Survey of services for adults with visual impairment living in London 39 Resource centres display a wide range of assistive technology and staff are available to demonstrate the equipment and give advice. The centres and staff are provided by both the voluntary sector and social services.

Resource centres that display equipment specifically for visually impaired people were surveyed.

Findings  There is one regional resource centre in the borough of Camden, with staff available 5 days a week, during office hours.

12 local borough resource centres, of which:  Five open during office hours with staff available on request or by appointment, in the following boroughs: Bromley, Havering, Merton, Sutton and Wandsworth  Eight open 1 to 3 times a week, or by appointment 5 days a week. This services is available in: Barnet, Bexley, Harrow, Hounslow, Kingston, Redbridge, Richmond and Tower Hamlets  Enfield has monthly equipment advice session and Croydon and Haringey demonstrate on request a selection of equipment

Residents in all 33 boroughs have access to information and advice regarding assistive technology, including a home visit if necessary, provided by a national voluntary sector organisation.

14. Welfare benefits support

Visually impaired people can find filling the application form for welfare benefits a barrier and may not apply unless assistance is received. Also an accurate description of the impact of visual impairment on daily life needs to be provided. Advice and assistance from experienced staff can increase the likelihood of a successful application. Findings  One-to-one support to apply for welfare benefits and advocacy regarding appeals is available to all visually impaired people

A Vision for London: Survey of services for adults with visual impairment living in London 40 resident in London, across the 33 boroughs, provided by a national voluntary organisation  In addition to this service, 17 boroughs provide a welfare benefits officer employed by a voluntary organisation or a Citizens Advice Bureau officer who has received specialised training on giving advice to visually impaired people The boroughs where these services are available are as follows: Bromley, Camden, City of London, Greenwich, Hackney, Hammersmith & Fulham, Havering, Islington, Kensington & Chelsea, Kingston, Lambeth, Lewisham, Merton, Southwark, Tower Hamlets, Wandsworth and Westminster.

15. Concessions

One-to-one support can enable visually impaired people to apply for concessions such as the disabled person’s freedom pass, membership of Dial-a-Ride or Computer Cab, free directory enquiries, CD/radios from British Wireless for the Blind fund and membership of leisure schemes such as VocalEyes.

Findings One-to-one support is offered by voluntary sector staff and some rehabilitation officers in 30 of the 33 boroughs. The boroughs that do not provide support are Bromley, Newham and Redbridge. This service is usually provided by home visitors or befrienders described in an earlier section of the report.

16. Housing repairs/issues

One-to-one support to obtain more appropriate housing or to organise repairs to the property, including follow up work, was surveyed.

Findings

A Vision for London: Survey of services for adults with visual impairment living in London 41 This support is provided by a national voluntary organisation on a regional basis to all London residents that are visually impaired. The following 20 boroughs have additional local support: Barnet, Brent, Ealing, Enfield, Harrow and Hounslow have a staff member employed by a voluntary organisation to help service users remain independent in their own homes. There are home visitors in Camden, City of London, Greenwich, Hackney, Hammersmith & Fulham, Islington, Kensington & Chelsea, Lambeth, Lewisham, Southwark, Tower Hamlets, Wandsworth and Westminster who provide this type of support. Support is also given in Croydon.

17. Reading correspondence

Many people with visual impairment need regular support to access correspondence and other documents sent through the post, especially if they do not have a friend or relative at hand to help them. Home visitors or befrienders provide this support and occasionally it is funded by individual budgets or direct payments.

Findings This kind of support is available in all boroughs apart from Havering, Newham and Redbridge.

18. Social activities

Visual impairment can curtail interests, hobbies and contact with friends or relatives and as a result people who are visual impaired often feel lonely and isolated. Many visually impaired people lack the confidence to attend mainstream activities with sighted people and prefer classes and groups that cater exclusively for people with a visual impairment, where tutors will have a good awareness of their needs. These recreational activities provide social contact, peer support, information and a sense of belonging to a community.

A Vision for London: Survey of services for adults with visual impairment living in London 42 Specialised recreational activities have been sub-divided into social activities, leisure activities and physical or sporting activities. However, each category is not mutually exclusive as social contact takes place during leisure activities and an important element of sports and physical activities is the opportunity for social interaction.

Regular lunch clubs, social or support groups specifically for the visually impaired are provided by the voluntary sector. Groups meet weekly, fortnightly or monthly.

Findings The survey findings show great variance in the numbers of groups in each borough, with one borough having 12 groups and 4 without any at all. The number of regular groups, available to all adults who are visually impaired in each borough is as follows: 12 Bromley 7 Croydon 6 Waltham Forest 5 Hillingdon 4 Kingston and Sutton 3 Bexley, Harrow and Merton 2 Enfield, Hammersmith & Fulham, Haringey, Havering, Islington, Kensington & Chelsea, Richmond, Southwark and Tower Hamlets 1 Barnet, Brent, Camden, Ealing, Greenwich, Lewisham, Newham, Redbridge and Wandsworth 0 Barking & Dagenham, City of London, Hackney, Hounslow, Lambeth and Westminster

A Vision for London: Survey of services for adults with visual impairment living in London 43 Fig. 3: Number of social groups in each borough

A Vision for London: Survey of services for adults with visual impairment living in London 44 There are also regular meetings for specific groups of people, such as those with glaucoma or retinitis pigmentosa, or Christian groups. The membership criteria for the groups and boroughs in which they meet are as follows:  Barking & Dagenham: Younger women (30s & 40s)  Bromley, Havering, Southwark: Torch Trust groups for Christians  Croydon: Retinitis Pigmentosa Support Group  Ealing: Monthly younger persons’ social club (40s & 50s)  Havering: Glaucoma group (a glaucoma group has also started in Westminster, but is not meeting regularly yet)  Havering: Partially Sighted Society group  Hillingdon and Barking & Dagenham have groups for women  Sutton: Men’s group  Tower Hamlets: BME group  Wandsworth: Over 50s group

Macular Disease Society support groups were also surveyed. They are available in the following 12 boroughs: Bexley, Bromley, Camden, Croydon, Enfield, Greenwich, Havering, Hillingdon, Kingston, Richmond, Sutton and Wandsworth.

The British Retinitis Pigmentosa Society organises twice yearly social gatherings, around the times the clocks change.

Social gatherings for special events or seasonal celebrations also take place. However, this area was not comprehensively surveyed.

19. Leisure activities

The survey indicated that in some boroughs the voluntary sector provides a range of activities which includes; pottery, drama, arts and crafts, quizzes, music and poetry appreciation, gardening, needlework and knitting. Most of these activities take place on a weekly basis. The number of activities varies greatly from one borough to another with three boroughs providing a

A Vision for London: Survey of services for adults with visual impairment living in London 45 range of 6 activities, while in 16 boroughs there are no activities at all specially for people who are visually impaired.

Findings The numbers of regular activities and the boroughs are listed below. 6 Croydon, Hillingdon and Merton 4 Haringey and Wandsworth 3 Sutton 2 Bromley, Kensington & Chelsea 1 Camden, Greenwich, Havering, Islington, Kingston, Newham, Richmond 0 Barking & Dagenham, Barnet, Bexley, Brent, City of London, Ealing, Hackney, Hammersmith & Fulham, Harrow, Hounslow, Lambeth, Lewisham, Southwark, Tower Hamlets, Waltham Forest and Westminster

Enfield and Redbridge provide occasional outings only.

This information is also provided in the bar chart (Fig. 4).

A Vision for London: Survey of services for adults with visual impairment living in London 46 Fig. 4: Number of activities in each borough

A Vision for London: Survey of services for adults with visual impairment living in London 47 20. Physical or sporting activities

People, who are visually impaired, particularly when older, may not have the confidence to access mainstream provision of sports or exercise classes. In two boroughs, (Bromley and Kingston) this has been addressed by the provision of one-to-one support to accompany people to the local borough’s leisure centre. In Waltham Forest a course to introduce people with a visual impairment to the leisure centre was organised.

The survey showed that some boroughs have a wide range of regular physical activities specifically for visually impaired people, provided regularly by the voluntary sector. The activities include: keep fit, falls prevention exercises, swimming, bowls, sound ball tennis, goal ball, dancing, tai chi, yoga, walking, to tandem bike riding.

Findings The widest range provided in one borough is 8 types of exercise. However, respondents in 13 boroughs reported that they were not aware of any physical or sporting activities for people who are visually impaired in their borough.

The number of types of regular physical exercise in each borough follows: 8 Merton 5 Croydon 3 Kingston, Newham, Wandsworth 2 Barnet, Bexley, Bromley, Enfield, Hackney, Haringey, Lewisham, Richmond 1 Brent, Hillingdon, Islington, Sutton 0 Barking & Dagenham, Camden, City of London, Ealing, Hammersmith & Fulham, Harrow, Havering, Hounslow, Lambeth, Redbridge, Southwark, Tower Hamlets, Westminster

The information is also provided in the bar chart (Fig. 5) on page 48.

A Vision for London: Survey of services for adults with visual impairment living in London 48 The following boroughs have short courses when funding allows: Greenwich, Kensington & Chelsea and Waltham Forest. The activities vary, in Waltham Forest they include: Pilates, spinning, aerobics, and bowls. In Greenwich there are keep-fit exercises and in Kensington & Chelsea there is yoga or chair based exercises. Hillingdon provides occasional walks for women who are visually impaired.

A Vision for London: Survey of services for adults with visual impairment living in London 49 Fig. 5: Number of physical activities available in each borough

A Vision for London: Survey of services for adults with visual impairment living in London 50 21. Talking newspapers

Talking newspapers provide a valuable means of keeping in touch with local news and events. They also inform visually impaired people of new services and initiatives, which they may not hear of otherwise.

Findings Talking newspapers are provided in all but 5 boroughs, (Camden, City of London, Lambeth, Hammersmith & Fulham and Southwark). In most boroughs they are produced by a voluntary organisation or a group of volunteers.

London Sounds, an all London talking newspaper provided by Action Trust, in Hammersmith & Fulham was temporarily unavailable at the time of the survey.

22. Directories of services/information leaflets

Information about services for people with visually impairment can be difficult to obtain, because there are many different providers. Directories of services provide information about local services and in some cases they include descriptions of London wide and national services, in accessible formats. They are often produced in a cross sector partnership between, PCTs, social services and the voluntary sector.

The findings of the survey indicated that a variety of information was available, either in the form of leaflets, mainly about a particular service, or full directories encompassing many services.

Findings Information on services specifically for visually impaired people are provided in the following boroughs: Barnet, Bexley, Croydon, Greenwich, Hackney, Haringey, Harrow, Havering Hounslow, Islington, Kingston, Lewisham, Newham, Redbridge, Richmond, Southwark, Sutton, Tower Hamlets, Waltham Forest.

A Vision for London: Survey of services for adults with visual impairment living in London 51 23. General information on services

General information on services for people who are visually impaired is provided in all boroughs, by both rehabilitation officers and staff from the voluntary sector, when available.

24. Specialised housing for people with visual impairment

 Six boroughs have houses, flats or residential homes specifically for adults with visual impairment, with staff available to provided assistance if needed. The boroughs are Barnet, Brent, Hammersmith & Fulham, Redbridge, Southwark and Wandsworth  In Barnet there is housing for those that are working provided by a housing association and housing for Jewish people provided by a voluntary organisation  In Brent and Redbridge there is housing for Jewish people only  In Hammersmith & Fulham it is mainly for those of working age

25. Low vision services committees

Responsibility for the coordination and planning of local services for visually impaired people is usually delegated to a low vision services committee (LVSC) or a sub group of the local strategic partnership board. They provide a forum within the local authority for professionals from the health, social care and voluntary sector to discuss improvements needed in services at a London borough level. Service users also join local committees to give feedback about services and to be involved in the planning of future services. In some areas the committees reflect the primary care trust boundaries and involve more than one borough.

The professionals involved differ from borough to borough, but can include:  PCT commissioners for community and acute services  Social services commissioners for sensory services  Hospital trust representation

A Vision for London: Survey of services for adults with visual impairment living in London 52  Consultant ophthalmologists  Optometric advisors  Local Optical Committee representation  Dispensing opticians  Orthoptists  Ophthalmic nurses  GP’s with an interest in ophthalmology  Sensory team managers and rehabilitation officers/social workers  Specialist sector workers in the field of employment, education, older people, hearing impairment, learning difficulties and multiple disabilities.  Specialist teachers for children and young people  Voluntary sector staff  Service users (including those from BME groups)

Findings The following 19 boroughs have LVSC or a similar group: Barking & Dagenham, Barnet, Croydon, Ealing, Enfield, Haringey, Havering, Hillingdon, Hounslow, Islington, Kensington & Chelsea, Kingston, Lambeth, Merton, Newham, Southwark, Sutton, Tower Hamlets and Wandsworth Professionals and service users from Richmond attend the committee in Kingston.

Local eye health groups, sometimes called eye care modernisation groups or strategy groups, provide advice about eye care services. These groups were not surveyed.

Overview of all surveyed services From the information presented so far it is clear that the range of services in each borough varies considerably. However, the findings presented above do not show whether the overall numbers of services available to adults who are visually impaired is relatively constant or alternatively that residents in some boroughs have access to more services and a greater variety of services than those living in other parts of London.

A Vision for London: Survey of services for adults with visual impairment living in London 53 The table presented on pages 53-60 and in the bar chart on page 61 compares service provision across all boroughs.

Table 2 lists the following services in each of the 33 boroughs:  Number of registered adults in each borough  Number of rehabilitation posts  Hospital eye clinic based services, which includes the existence of ophthalmology departments, optometric low vision services and information & support services (I & S service)  All other services in the list of 24 services surveyed, except regular recreational activities which are shown separately.  A low vision service committee that met regularly at the time of the survey

Social gatherings for specific groups such as macular degeneration, glaucoma, or Torch Trust Christian groups have not been included.

Table 2 and Fig. 6 indicate that variations across boroughs found in respect of individual services is magnified when the data is aggregated. The histogram on page 61 shows that same data with different colours used to highlight the number of hospital based services, the number rehabilitation posts, the number of other services etc. The histogram does not show the number of people registered in each borough.

A Vision for London: Survey of services for adults with visual impairment living in London 54 Table 2: Overview of all services

Borough Number of Number of Hospital Number Number of LVSC Registered Rehab. based of other Recreational Adults Posts Services Services Activities Croydon 1640 2 Full-time Ophthalmic 4 Part-time department 16 18 Yes Optom. LVS I & S service

Merton 1090 1 Full-time I & S service 16 17 Yes

Hillingdon 1315 4 Full-time Ophthalmic department 13 12 Yes Optom. LVS I & S service

Bromley 1915 3 Full-time Ophthalmic 13 16 No 1 Part-time department

A Vision for London: Survey of services for adults with visual impairment living in London 55 Borough Number of Number of Hospital Number Number of LVSC Registered Rehab. based of other Recreational Adults Posts Services Services Activities 1375 2 Full-time Ophthalmic Wandsworth department 17 8 Yes Optom. LVS I & S service 2 Full-time Ophthalmic Islington 1245 1 Part-time department 18 4 No Optom. LVS I & S service

1 Full-time Ophthalmic Kingston 570 1 Part-time department 16 8 No Opto.LVS I & S service

Sutton 1080 2 Full-time Ophthalmic 1 Part-time department 15 8 Yes Optom.LVS I & S service

A Vision for London: Survey of services for adults with visual impairment living in London 56 Borough Number of Number of Hospital Number Number of LVSC Registered Rehab. based of other Recreational Adults Posts Services Services Activities 1 Full-time Bexley 810 2 Part-time Ophthalmic 16 5 No & department 1 Full-time Optom. LVS Assistant 1 Part-time Assistant

2 Full-time Ophthalmic Barnet 1775 2 Assistants department x 15 3 Yes 2 Optom.LVS I & S service Haringey 2 Full-time Ophthalmic 1565 department 13 8 Yes I & S service

A Vision for London: Survey of services for adults with visual impairment living in London 57 Borough Number of Number of Hospital Number Number of LVSC Registered Rehab. based of other Recreational Adults Posts Services Services Activities 2 Hospital 16 2 Camden 1285 2 Full-time Ophthalmic No departments Optom. LVS I & S service

1 Full-time Ophthalmic 14 3 Havering 855 2 Assistants department No Optom. LVS I & S service

3 Full-time Ophthalmic 16 3 Lewisham 1070 1 Part-time department No I & S service

Tower 790 3 Full-time 2 Hospital 16 2 Hamlets Ophthalmic Yes departments Optom. LVS

A Vision for London: Survey of services for adults with visual impairment living in London 58 Borough Number of Number of Hospital Number Number of LVSC Registered Rehab. based of other Recreational Adults Posts Services Services Activities Hackney 975 4 Full-time Ophthalmic 17 2 department No

Richmond 605 3 Full-time I & S service 15 5 No

Enfield 990 2 Full-time Ophthalmic 12 4 1 Part-time department Yes Optom. LVS I & S service Ken & 810 Ophthalmic 15 4 Chelsea 2 Full-time department Yes

Southwark 1215 2 Full-time I & S service 17 2 No Waltham 450 1 Full-time Eye clinic 14 6 Forest Optom. LVS No

A Vision for London: Survey of services for adults with visual impairment living in London 59 Borough Number of Number of Hospital Number Number of LVSC Registered Rehab. based of other Recreational Adults Posts Services Services Activities Brent 2260 3 Full-time Ophthalmic 14 2 department No Optom. LVS I & S service Lambeth 980 1 Full-time 2 Hospital 14 0 Ophthalmic Yes departments Optom. LVS I & S service x 2 Newham 1510 2 Full-time Ophthalmic 11 5 1 Part-time department Yes

Ealing 1590 2 Full-time Ophthalmic 13 1 & department Yes 1 Part-time Optom. LVS Assistant I & S service

A Vision for London: Survey of services for adults with visual impairment living in London 60 Borough Number of Number of Hospital Number Number of LVSC Registered Rehab. based of other Recreational Adults Posts Services Services Activities Greenwich 1030 3 Full-time Eye clinic 13 2 No

Hammersmith 810 1 Full-time Ophthalmic 14 2 No & Fulham department Optom. LVS

Harrow 1115 1 Full-time Ophthalmic 12 3 1 Part-time department No Optom. LVS

Hounslow 1365 2 Full-time Ophthalmic 14 0 department Yes I & S service

A Vision for London: Survey of services for adults with visual impairment living in London 61 Borough Number of Number of Hospital Number Number of LVSC Registered Rehab. based of other Recreational Adults Posts Services Services Activities Barking & 695 2 Full-time Ophthalmic 13 0 Dagenham department Yes

Westminster 1345 2 Full-time Ophthalmic 12 0 No department Optom. LVS

City of 15 1 Full-time Ophthalmic 12 0 No London department Optom. LVS Redbridge 1690 1 Full-time Ophthalmic 10 1 No department Optom. LVS

A Vision for London: Survey of services for adults with visual impairment living in London 62 Fig. 6: Overview of all services, histogram

A Vision for London: Survey of services for adults with visual impairment living in London 63 Other services for people who are visually impaired The information presented above covers 24 type of services included in the survey. However, it was not fully comprehensive and other services, specifically, for visually impaired people are available in some boroughs but were not identified until the process of data collection was well underway. In retrospect some of these services should have been included in the survey for example, the libraries that provide equipment specifically for visually impaired people.

When information on these services was provided it was noted under ‘Other services for people who are visually impaired’. Most of these services are provided by the voluntary sector. Because these services were not surveyed systematically it is likely that some of these services are available in boroughs other than those mentioned below. However, they are included because they illustrate the diversity of need among people with visual impairment and the extent to which creative approaches and innovative service solutions have been found.

The type of services and the boroughs where each service is available is listed below. The most frequently provided services are listed first:

 British Wireless for the Blind agents in 18 boroughs: Bexley, Camden, City of London, Ealing, Greenwich, Hackney, Hammersmith & Fulham, Haringey, Islington, Kensington & Chelsea, Lambeth, Lewisham, Merton, Southwark, Sutton, Tower Hamlets, Wandsworth, Westminster  Direct Payments budget advocacy in 18 boroughs: Barking & Dagenham, Brent, Camden, Croydon, Ealing, Enfield, Greenwich, Hammersmith & Fulham, Havering, Hillingdon, Islington, Lambeth, Lewisham, Merton, Newham, Redbridge, Wandsworth, Westminster  Talking newsletter (as distinct from talking newspapers) covering 13 boroughs: Camden, City of London, Greenwich, Hackney,

A Vision for London: Survey of services for adults with visual impairment living in London 64 Hammersmith & Fulham, Islington, Kensington & Chelsea, Lambeth, Lewisham, Southwark, Tower Hamlets, Wandsworth and Westminster  Local borough talking newsletter or magazine: Ealing, Haringey, Hillingdon, Kensington & Chelsea, Kingston, Lambeth, Lewisham, Southwark, Sutton  Door to door transport provided by a voluntary group to and from their premises for people who are visually impaired: Croydon, Merton, Kingston, Redbridge, Sutton

 Optometric domiciliary low vision service: Barnet, Islington, Kensington & Chelsea, Lewisham and Newham  Healthy eating courses (at the premises of voluntary groups for people with visual impairment): Bexley, Croydon, Greenwich, Merton  Optometric low vision service in high street practices: Barnet, Enfield, Haringey  Local voluntary group’s talking library: Haringey, Redbridge, Sutton  Provision of refurbished Pentium 3: Lambeth, Southwark, Westminster  Libraries with equipment for specifically for people who are visually impaired (CCTV, large screen magnifiers and audio programmes for computers etc): Haringey, Southwark  Asian language talking newspapers: Punjabi in Ealing, Sylheti and Bengali in Tower Hamlets  Events for newly registered people: Havering, Merton  Equipment awareness events: Lambeth, Sutton  Chiropody or foot care at a voluntary group’s premises: Croydon, Merton  Triage Centre, staff include a consultant ophthalmologist: Merton

A Vision for London: Survey of services for adults with visual impairment living in London 65  Health check involving a partnership between a local VI voluntary organistion and Age Concern: Merton  Citizens Advice Bureau monthly debt advice: Tower Hamlets

 Reading groups in the local library: Bromley  Audio described videos: Southwark  Provision of audio description at a local museum: Southwark  Handy person or sewing buddy: Kingston  Sale of non-perishable goods by voluntary group for people with visual impairment: Croydon  Hairdressing for people with visual impairment at voluntary group’s premises: Croydon

Other initiatives Initiatives such as visual awareness training, access audits on buildings and raising awareness of visual impaired people’s needs are noted because, although they are not direct services, they can improve the quality of visually impaired people’s lives. However, they were not part of the survey, so other initiatives may be taking place in boroughs not mentioned below.

Other initiatives and the boroughs in which they take place noted are listed below:  Visual awareness training: Barnet, Brent, Bromley, Croydon, Ealing, Enfield, Hackney, Harrow, Hillingdon, Hounslow, Merton, Richmond  Access audits on buildings: Barnet, Brent, Ealing, Enfield, Hackney, Harrow, Hillingdon, Hounslow, Richmond  Raising awareness of needs of people who are visually impaired: Haringey, Merton, Richmond  Services User Participation Groups: Merton

A Vision for London: Survey of services for adults with visual impairment living in London 66 Conclusions The survey of services for adults who are visually impaired in the 32 London boroughs and the City of London completed in September 2009 shows:

1. When each type of service is considered separately, the findings of the survey show wide differences regarding the availability of each service in different boroughs. For instance, some boroughs have several rehabilitation staff, a wide range of services and many different regular social and leisure activities, while other boroughs have few rehabilitation officers, provide fewer services and no social or leisure opportunities.

2. The extent of variation across boroughs is compounded when the information on different services is aggregated, suggesting even larger differences in the number and range of services available to visually impaired people.

3. The extent to which a person can expect to receive appropriate advice, information, assistance and support to adjust to sight loss varies from one borough to another.

4. PCTs, local authorities and the voluntary sector all play an important role in the provision of services.

A Vision for London: Survey of services for adults with visual impairment living in London 67 Recommendations The future configuration of services for visually impaired people in London will be affected by demographic changes, government policy and the available resources. Hopefully, it will also draw on the breadth and depth of existing service provision, reported in this survey, and the National Vision Strategy, launched in 2009.

Across the 32 boroughs and the City of London there is enormous diversity in the range of services on offer to visually impaired people. To the extent that these services reflect local solutions to supporting choice, independence and inclusion for visually impaired people, they are a good indication of the many different kinds of provision that may be needed in the future. Following this section there is a short summary of the services that might be considered as a ‘standard’ requirement, those that are ‘additional’ and those that are ‘optimum’.

Recommendation 1

We recommend commissioners in each borough adopt the findings set out in this report, or alternatively, conduct an audit of current service provision, and then set targets for the development of services to meet the needs of visually impaired people.

The survey confirms that visually impaired people depend upon a mixed economy of service provision with important contributions from the statutory providers (health and social services) and a plethora of voluntary sector agencies. The advantages of this approach lies in its flexibility and the scope it offers for responding to changing needs and circumstances with new kinds of support. The disadvantage is that services evolve independently with little coordination within each borough and few opportunities for sharing good practice across boroughs. Currently the main forum for reviewing service provision and planning improved services is the Low Vision Service Committee. However there appears to be considerable variation regarding their effectiveness.

A Vision for London: Survey of services for adults with visual impairment living in London 68 Recommendation 2

We recommend that each borough reviews the effectiveness of its low vision service committee (LVSC) (or equivalent) and takes steps to ensure representation from commissioners, lead officers with responsibility for sensory impairment and representatives from voluntary sector agencies.

Recommendation 3

We propose that each LVSC is made responsible for the delivery of improved services.

Recommendation 4

We propose that each LVSC is invited to issue an annual report that sets out its proposals for developing services to meet the needs of visually impaired people and that these reports are shared with other LVSCs

Recommendation 5

We also recommend that all boroughs attend the London wide low vision services committee meetings being organised under the auspices of Vision 2020.

Demography The demography of London is relevant to planning of future services because certain groups are more at risk of becoming visually impaired such as older people, BME communities and those that have diabetes or smoke. (Ref. 9-11 & Appendix 5).

A Vision for London: Survey of services for adults with visual impairment living in London 69 Meeting the needs of adults who are visually impaired Proposed benchmarks for service development, set out below, are based on the services described in this report and priorities identified in government policies. They are a starting point for discussion with all sectors involved in providing services for people who are visually impaired.

The services listed in this section are specifically for adults who are visually impaired, with the exception of transport.

Transport is included because without accessible public transport and efficient door to door transport many services and activities cannot be accessed by visually impaired people.

There are three levels of provision are suggested.  Standard services  Additional services  Optimum services

Standard services are those considered necessary to meet the range of needs likely to be presented by service users in each borough, to promote independence, prevent deterioration in physical and mental health and enable people to participate as active citizens.

Additional services are those that would improve independence and further reduce the risk of adverse consequences of visual impairment.

Optimum services are those that would increase choice and provide help for people with visual impairment to obtain a quality of life similar to their sighted peers.

LVIF recommends that all boroughs provide the services listed as the ‘Standard’ range of services.

All services should be accessible to all visually impaired residents in London, including those with learning difficulties, members of black and ethnic minorities and older people with mobility difficulties. It is essential that information about services is provided in accessible formats such as

A Vision for London: Survey of services for adults with visual impairment living in London 70 large print, audio and Braille, to ensure that it reaches those who most need to benefit.

The services are listed under the following headings:  Services to support independence  Information and support to access services  Employment, equipment & training  Leisure activities  Planning & awareness of service user needs

Standard services

Services to support independence  Accessible public transport  Standardised, efficient, reliable subsidised door to door transport  Easy access to ophthalmic services  Easy to access optometric low vision services  Enhanced optometric services for people with learning difficulties and other groups identified as marginalised  Rehabilitation services (provided or contracted by social services).  Social services to publish information on:  Number of rehabilitation officer posts in relation to the number of people registered as sight impaired/severely sight impaired within the borough

 Assessment times from receipt of certificate of registration

 One-to-one support to go shopping

Information & support to access services  Support & information services in hospital eye clinics  Outreach to marginalised groups, (people with learning difficulties, members of BME communities and older people with mobility difficulties)  Information and one-to-one support to access services, welfare benefits and concessions

A Vision for London: Survey of services for adults with visual impairment living in London 71  One-to-one support to access housing repairs  Regular one-to-one support for reading correspondence  British Wireless for the Blind agent  Talking newspaper

Employment, equipment & training  Employment support, specifically for visually impaired people  Resource centre/assistive technology advise  IT training  Braille training  Emotional support  All libraries to provide computers with accessible programmes and CCTVs or large screen magnifiers

Leisure activities  At least one activity group (pottery, art & crafts, music appreciation)  At least one social group  At least one physical exercise group (keep fit, dancing, swimming)  Talking books and newsletters

Planning & awareness of service user needs  Low vision service committee/VI sub group of strategic partnership committee, (members should include service users)  Consultation & raising awareness of the needs of people who are visually impaired at local borough level  Service user consultation groups  Visual awareness training for professionals & others  Accessibility audits (by visual impaired people of services provider’s buildings)

Additional services

(provided in addition to the ‘standard’ services)

Information & support to access to services  Outreach drop in by rehabilitation officers to libraries, civic offices  Directory of services

A Vision for London: Survey of services for adults with visual impairment living in London 72  Good links with local further education college  Home visiting/befriending and or tele-befriending  Individual budget support to access ‘personalisation’ services  BME language talking newspapers  Groups or events for newly registered people  Regular equipment awareness events

Leisure activities  3 or more recreational groups

Optimum services

(services provided in addition to standard and additional services)

Services to support independence  Easily accessible healthy eating courses/cookery skills  Handy person and a sewing service

Information and support to access services  Buddy scheme for leisure/recreational activities (e.g. local gym)

Leisure activities  A wide range of recreational groups  Day trips, outings and events to mark special occasions.  Reading groups at local libraries

A Vision for London: Survey of services for adults with visual impairment living in London 73 Appendices

Appendix 1: References

Ref.1: Registered Blind and Partially Sighted People Year ending 31st March 2008 England. Health and Social Care information Centre http://www.ic.nhs.uk/statistics-and-data-collections/social-care/adult-social- care-information/people-registered-as-blind-and-partially-sighted-2008- england

Ref.2: Improving the detection of correctable vision in older people, Thomas Pocklington Trust, Research Findings September 2008, number 18 http://www.pocklington-trust.org.uk/

Ref.3: Future Sight Loss UK (1): Economic impact of partial sight and blindness in the UK adult population. Report by Access Economics Pty Limited http://www.vision2020uk.org.uk/ukvisionstrategy/page.asp? section=74§ionTitle=Future+Sight+Loss+UK+Research

Ref.4: The UK Vision Strategy http://www.vision2020uk.org.uk/UKVisionstrategy/page.asp

Ref.5: Registered Blind and Partially Sighted People Year ending 31st March 2008 England. Health and Social Care information Centre http://www.ic.nhs.uk/statistics-and-data-collections/social-care/adult-social- care-information/people-registered-as-blind-and-partially-sighted-2008- england

Ref.6: Focus on London 2007 http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=10527

Ref.7: DMAG Briefing 2009-08, August 2009, GLA 2008 Round Ethnic Group Population Projections http://www.london.gov.uk/mayor/publications/facts-figures/population.jsp

A Vision for London: Survey of services for adults with visual impairment living in London 74 Ref.8: http://www.nhs.uk/conditions/Macular- degeneration/Pages/Introduction.aspx

Ref.9: http://www.nhs.uk/conditions/glaucoma/Pages/Introduction.aspx http://www.rnib.org.uk/xpedio/groups/public/documents/publicwebsite/publi c_rnib003655.hcsp

Ref.10: http://www.nhs.uk/Pathways/diabetes/Pages/Avoiding.aspx

Ref.11: http://www.nhs.uk/conditions/macular- degeneration/pages/causes.aspx www.rnib.org.uk/getinvolved/campaign/.../smokingfactsheetp.pdf

Ref.12: Future sight loss UK (1): The economic impact of partial sight and blindness in the UK adult population. Full report prepared for RNIB by Access Economics Pty Limited, July 2009 http://www.vision2020uk.org.uk/ukvisionstrategy/page.asp? section=74§ionTitle=Future+Sight+Loss+UK+Research

Ref.13: Our health, our care, our say: making it happen http://www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/DH_065882

Ref.14: Primary Care & Community Services: Improving eye health services http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publications PolicyAndGuidance/DH_103083

Ref.15: Transforming Adult Social Care, Local Authority Circular http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Local AuthorityCirculars/DH_095719

A Vision for London: Survey of services for adults with visual impairment living in London 75 Appendix 2: Glossary of terms & abbreviations

Glossary of terms

Consultant ophthalmologist: A qualified doctor who specialises in the medical and surgical care of the eyes and visual system.

Domiciliary service: A service delivered at a service users home

Glaucoma: Is the name given to a group of eye conditions in which the optic nerve damages causes sight loss.

Macular degeneration: An eye condition that causes the gradual loss of central vision. Central vision is used for activities such as reading, writing and driving. It is most commonly age related.

Optometrist: Professionals trained to recognise eye diseases, examine and test eyes as well as prescribe and dispense spectacles

Orthoptist: Professionals trained to diagnose and treat vision defects and abnormalities of eye movement. They see patients of all ages from infants to the elderly, but are particularly know for working with children.

Retinitis pigmentosa: Is the name given to a group of inherited diseases of the retina that lead to a gradual reduction in vision.

Sight impaired/severely sight impaired: Previously partially sighted/blind

Abbreviations

BME: Black and Minority Ethnic

CCTV: Close Circuit Television

CV: Curriculum Vitae

A Vision for London: Survey of services for adults with visual impairment living in London 76 EU: European Union

Guide Dogs: The Guide for the Blind Association

IT: Information Technology

LVSC: Low Vision Service Committee

LVS: Low Vision Services

NHS: National Health Service

PCT: Primary Care Trusts

RNIB: Royal National Institute for Blind People

UK: United Kingdom

VI: Visually Impaired

A Vision for London: Survey of services for adults with visual impairment living in London 77 Appendix 3: Registration as severely sight impaired & sight impaired

Generally, to be registered as severely sight impaired (blind), sight has to fall into one of the following categories:  Visual acuity of less than 3/60 with a full visual field  Visual acuity between 3/60 and 6/60 with a severe reduction of field of vision, such as tunnel vision  Visual acuity of 6/60 or above but with a much reduced field of vision, especially if a lot of sight is missing in the lower part of the field.

To be registered as sight impaired (partially sighted) your sight has to fall into one of the following categories:  Visual acuity of 3/60 to 6/60 with a full field of vision  Visual acuity of up to 6/24 with a moderate reduction of field of Vision or with a central part of vision that is cloudy or blurry  Visual acuity of up to 6/18 if a large part of your field of vision, for example a whole half of your vision is missing or a lot of your peripheral vision is missing.

Source: http://www.rnib.org.uk/xpedio/groups/public/documents/publicwebsite/publi c_cert_vi.hcsp

A Vision for London: Survey of services for adults with visual impairment living in London 78 Appendix 4: Number of blind and partially sighted people registered with councils by age group

4a: Number of blind people registered with councils by age group, at 31st March 2008 (Health and social care information centre)1

Total of nos. of people registered 0 to 4 5 to 17 18 to 49 50 to 64 65 to 74 75 or over

LONDON 21,650 80 630 3,225 2,470 2,275 12,970

Inner London 7,760 25 300 1,360 930 840 4,305

Camden 665 - 10 90 70 55 440 Greenwich 465 - 15 65 35 50 300 Hackney 590 - 35 120 80 80 270 Hammersmith & Fulham 520 - 15 110 80 50 255 Islington 680 - 10 115 90 80 380 Kensington & Chelsea 585 - 110 70 5 55 335 Lambeth 840 - 15 155 105 95 470 Lewisham 660 - 15 125 85 80 350 Southwark 750 - 45 145 120 80 360 Tower Hamlets 395 0 15 95 60 55 170 Wandsworth 785 - 10 155 105 100 410 Westminster 810 0 - 110 85 55 555 City of London 10 0 - - - - -

1 A Vision for London: Survey of services for adults with visual impairment living in London 79 Outer London 13,895 55 330 1,865 1,540 1,435 8,665

Barking & Dagenham 345 - 15 80 60 40 140 Barnet 950 5 25 125 120 90 580 Bexley 390 0 10 50 40 40 250 Brent 1,380 - 25 165 145 140 900 Bromley 955 - 15 90 75 65 710 Croydon 955 - 20 140 115 85 595 Ealing 970 0 15 130 105 155 570 Enfield 565 5 25 110 90 75 255 Haringey 915 0 5 120 100 115 575 Harrow 630 - 15 60 70 65 410 Havering 365 - 10 35 30 35 255 HIllingdon 645 - 20 100 75 45 405 Hounslow 750 - 30 90 75 75 475 Kingston-upon-Thames 345 - 10 50 35 25 220 Merton 590 - - 80 60 55 390 Newham 965 5 35 160 125 130 510 Redbridge 915 - 20 95 70 80 645 Richmond-upon-Thames 370 - 5 50 50 25 235 Sutton 595 - 10 80 65 40 390 Waltham Forest 305 - 5 50 30 50 165

Source: Health and Social Care information Centre http://www.ic.nhs.uk/statistics-and-data-collections/social-care/adult-social-care-information/people-registered-as- blind-and-partially-sighted-2008-england

A Vision for London: Survey of services for adults with visual impairment living in London 80 4b: Number of partially sighted people registered with councils by age group, at 31st March 2008: (Health and social care information centre)

Total Number of Partially Sighted people registered who are aged: Number of 0 to 5 to 18 to 50 to 75 or people 4 17 49 64 65 to 74 over registered LONDON 17,665 65 690 2,605 1,875 1,775 10,650

Inner London 5,720 15 180 990 710 595 3,235

Camden 640 - 10 80 50 50 450 Greenwich 600 0 20 55 55 50 420 Hackney 450 - 30 90 65 60 210 Ham.& Fulham 330 - 15 75 50 30 160 Islington 600 - 20 110 75 65 330 Ken.& Chelsea 355 0 10 65 45 35 200 Lambeth 160 0 5 0 30 0 125 Lewisham 450 - 20 110 60 50 210 Southwark 520 - 10 115 75 75 245 Tower Hamlets 430 0 20 110 60 55 185 Wandsworth 630 - 20 105 80 75 345 Westminster 540 0 0 75 60 50 355 City of London 20 0 0 - 0 - 15

Outer London 11,940 55 505 1,620 1,170 1,175 7,420

Bark. & Dag. 395 - 15 45 55 30 245 Barnet 905 5 40 115 85 95 565 Bexley 450 - 15 70 30 30 300 Brent 935 - 25 145 95 95 575 Bromley 1,020 - 40 105 85 95 690 Croydon 745 - 35 120 75 65 445 Ealing 650 - 20 105 75 80 370 Enfield 500 - 35 85 65 45 265 Haringey 685 0 30 115 75 70 395 Harrow 530 A Vision- for London: Survey20 of services for adults70 with visual impairment40 living in London60 340 81 Havering 510 - 10 35 45 60 360 HIllingdon 730 - 40 100 80 60 450 Hounslow 710 - 55 75 70 80 425 2 Source: Health and Social Care information Centre http://www.ic.nhs.uk/statistics-and-data-collections/social-care/adult-social-care-information/people- registered-as-blind-and-partially-sighted-2008-england

A Vision for London: Survey of services for adults with visual impairment living in London 82 Appendix 5: Resident population: London boroughs by age, 2005: (Office of National Statistics)2

All People (percentages) Percentages

80 and All 0 to 4 5 to 15 16 to 19 20 to 24 25 to 44 45 to 59 60 to 64 65 to 79 over ages

United Kingdom 13.6 5.3 6.5 28.5 19.3 5.2 11.6 4.4 100.0

England 5.7 13.5 5.2 6.5 28.7 19.2 5.1 11.5 4.4 100.0

London3 6.6 12.7 4.9 7.4 36.6 16.3 3.7 8.5 3.3 100.0

Inner London 6.8 11.4 4.7 8.5 41.8 14.2 3.1 6.9 2.6 100.0 Inner London - West 5.7 9.1 4.1 9.4 44.2 14.2 3.3 7.1 2.9 100.0 Camden 5.9 10.0 4.7 10.2 42.5 14.2 3.2 6.7 2.5 100.0 City of London 3.0 6.1 3.2 8.7 43.5 19.9 4.9 7.8 3.0 100.0 Hammersmith and Fulham 5.9 9.9 4.0 8.4 44.8 14.1 3.1 7.1 2.7 100.0 Kensington and Chelsea 5.3 9.3 4.2 9.7 41.0 15.6 4.0 7.7 3.2 100.0 Wandsworth 6.4 9.0 3.4 7.2 48.4 12.9 2.9 6.8 3.0 100.0 Westminster 4.9 7.9 4.6 11.6 42.9 14.4 3.5 7.4 2.9 100.0

Inner London - East 7.5 12.7 5.1 8.0 40.4 14.2 2.9 6.8 2.4 100.0 Hackney 8.5 13.9 5.2 7.6 38.8 14.2 2.9 6.5 2.4 100.0 Haringey 7.4 12.2 5.1 7.4 40.2 15.1 3.2 7.2 2.2 100.0 Islington 6.0 10.7 4.7 8.9 43.0 14.1 3.2 7.1 2.3 100.0 Lambeth 7.0 11.3 4.3 7.1 45.1 13.7 2.8 6.5 2.3 100.0 Lewisham 7.0 13.2 5.0 6.8 38.7 15.8 3.2 7.5 2.9 100.0 Newham 8.8 15.3 6.4 9.2 34.7 14.3 2.7 6.3 2.2 100.0 Southwark 7.0 12.0 4.7 7.7 41.0 14.8 2.9 7.1 2.7 100.0 Tower Hamlets 7.8 13.1 5.4 9.6 41.9 11.5 2.4 6.2 2.0 100.0 Outer London 6.5 13.5 5.1 6.7 33.1 17.8 4.1 9.5 3.8 100.0 Outer London - East and N. East 6.7 14.2 5.2 6.7 31.7 17.7 4.2 9.8 3.9 100.0 Barking and Dagenham 7.7 16.0 5.2 7.0 31.0 16.3 3.6 9.2 4.1 100.0

2 A Vision for London: Survey of services for adults with visual impairment living in London 83 Bexley 5.9 14.5 5.3 5.8 28.4 19.2 4.8 11.6 4.4 100.0 Enfield 7.0 13.9 5.2 6.6 31.8 17.8 4.2 9.7 3.8 100.0 Greenwich 7.1 13.3 5.2 7.6 35.2 16.2 3.6 8.2 3.5 100.0 Havering 5.4 14.0 5.1 5.8 26.7 20.2 5.1 12.9 4.8 100.0 Redbridge 6.6 14.6 5.2 6.8 31.4 18.2 4.1 9.3 3.8 100.0 Waltham Forest 7.4 13.5 5.1 7.0 36.7 15.8 3.6 7.9 3.0 100.0

Outer London - South 6.1 13.6 4.9 6.1 32.9 18.3 4.3 9.7 4.1 100.0 Bromley 5.9 13.8 4.6 5.0 29.8 19.3 4.9 11.7 5.0 100.0 Croydon 6.3 14.4 5.3 6.5 32.6 18.2 4.2 9.0 3.5 100.0 Kingston upon Thames 5.9 12.3 5.0 8.4 34.2 17.8 3.9 8.4 4.0 100.0 Merton 6.3 12.2 4.5 6.3 38.2 16.7 3.6 8.5 3.7 100.0 Sutton 5.9 14.5 5.0 5.2 31.6 18.7 4.4 10.2 4.4 100.0

Outer London - West and N. West 6.6 12.9 5.1 7.0 34.5 17.4 4.0 9.0 3.5 100.0 Barnet 6.4 13.4 4.7 6.5 33.6 17.5 4.1 9.5 4.2 100.0 Brent 6.7 12.1 5.3 8.0 36.2 16.2 3.8 8.9 2.7 100.0 Ealing 6.7 12.4 5.0 7.0 36.9 16.9 3.7 8.3 3.1 100.0 Harrow 6.2 13.4 5.7 6.3 31.5 18.5 4.3 10.1 4.1 100.0 Hillingdon 6.4 13.9 5.5 7.7 31.4 17.6 4.1 9.7 3.7 100.0 Hounslow 7.1 12.8 5.3 7.3 35.4 17.2 3.7 8.4 2.9 100.0 Richmond upon Thames 6.5 12.1 4.1 6.0 36.2 18.7 4.2 8.3 4.0 100.0

1 The mid-2005 population estimates are those published on 24 August 2006. 2 The estimated resident population of an area includes all people who usually live there, whatever their nationality. Members of HM and US Armed Forces in England and Wales are included on a residential basis wherever possible. HM Forces stationed outside England and Wales are not included. Students are taken to be resident at their term-time address. 3 Source: Office for National Statistics; General Register Office for Scotland; Northern Ireland Statistics and Research Agency http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=10527

Appendix 6: GLA 2008 Ethnic Group Population Projections, (GLA, DMAG Briefing 2009-08 August 2009)3

3 Source: GLA, DMAG Briefing 2009-08 http://www.london.gov.uk/mayor/publications/facts-figures/population.jsp A Vision for London: Survey of services for adults with visual impairment living in London 84 Projected Ethnic Groups, 2001-2031 2001 2006 2011 2016 2021 2026 2031 2006-31 2006-31 2006-31 % % of Change Change Change Total Population 7,336,900 7,448,800 7,797,700 8,156,800 8,373,000 8,540,000 8,788,700 1,339,900 17.99 100.00 White 5,216,100 5,022,700 5,057,800 5,138,100 5,168,500 5,199,200 5,304,800 282,100 5.62 21.06 Black Caribbean 351,000 361,800 378,900 396,300 407,900 417,200 429,600 67,800 18.73 5.06 Black African 389,700 450,700 509,800 563,000 594,900 618,100 644,100 193,400 42.91 14.43 Black Other 169,200 193,600 219,400 242,100 258,300 271,100 283,700 90,000 46.49 6.72 Indian 446,600 490,300 539,400 585,300 616,800 639,700 663,600 173,300 35.34 12.93 Pakistani 146,400 170,100 195,600 218,200 233,700 245,400 257,500 87,400 51.41 6.53 Bangladeshi 158,200 179,200 203,400 225,000 241,100 254,800 269,700 90,600 50.56 6.76 Other Asian 198,400 229,400 261,800 289,600 307,100 318,400 330,200 100,800 43.95 7.52 Chinese 82,400 97,800 112,800 126,200 135,500 142,700 150,600 52,800 53.96 3.94 Other 178,900 253,100 318,800 373,000 409,400 433,300 454,800 201,700 79.68 15.05 BAME 2,120,800 2,426,100 2,739,800 3,018,700 3,204,500 3,340,800 3,483,900 1,057,800 43.60 78.94 Figures may not add due to rounding

Appendix 7: Ethnic group populations as proportions of total population, 2001-20314

4 Source: GLA, DMAG Briefing 2009-08 http://www.london.gov.uk/mayor/publications/facts-figures/population.jsp

A Vision for London: Survey of services for adults with visual impairment living in London 85 Total Population (%) 2001 2006 2011 2016 2021 2026 2031 2006-31 Change White 71.09 67.43 64.86 62.99 61.73 60.88 60.36 -7.07 Black Caribbean 4.78 4.86 4.86 4.86 4.87 4.88 4.89 0.03 Black African 5.31 6.05 6.54 6.90 7.10 7.24 7.33 1.28 Black Other 2.31 2.60 2.81 2.97 3.09 3.17 3.23 0.63 Indian 6.09 6.58 6.92 7.18 7.37 7.49 7.55 0.97 Pakistani 2.00 2.28 2.51 2.68 2.79 2.87 2.93 0.65 Bangladeshi 2.16 2.41 2.61 2.76 2.88 2.98 3.07 0.66 Other Asian 2.70 3.08 3.36 3.55 3.67 3.73 3.76 0.68 Chinese 1.12 1.31 1.45 1.55 1.62 1.67 1.71 0.40 Other 2.44 3.40 4.09 4.57 4.89 5.07 5.18 1.78 BAME 28.91 32.57 35.14 37.01 38.27 39.12 39.64 7.07

A Vision for London: Survey of services for adults with visual impairment living in London 86 Appendix 8: Voluntary groups providing services and activities in London. (Only borough wide social groups have been included. The names of small social groups and talking newspapers have not been included).

Action for Blind People Action Trust for the Blind Barnet Borough Sight Impaired British Retinitis Pigmentosa Society Croydon Voluntary Association for the Blind Enfield Vision Essex Blind Charity Blind Independence Greenwich Haringey Phoenix Group Kent Association for the Blind Kingston Association for the Blind Macular Disease Society Merton Sports and Social Club for the Blind MertonVision Metropolitan Society for the Blind Metro Blind Sport Middlesex Association for the Blind Newham Voluntary Association for the Blind Organisation of Blind Africans & Caribbeans Royal London Society for the Blind SeeAbility

A Vision for London: Survey of services for adults with visual impairment living in London 87 Sight Action Havering Sutton Association for the Blind Thomas Pocklington Trust Visually Impaired in Camden Visually Impaired Society of Richmond VocalEyes

A Vision for London: Survey of services for adults with visual impairment living in London 88 Appendix 9: List of services surveyed

1. Ophthalmology departments 2. Optometric low vision services 3. Community low vision services 4. Information & support services in hospital eye clinics 5. Outreach services 6. Rehabilitation services 7. Specialised services for those with learning difficulties 8. Emotional support 9. Employment support 10. IT training 11. Braille training 12. Links to further education 13. Resource centre and assistive technology support services 14. Welfare benefits support 15. Concessions 16. Housing repairs/issues 17. Reading correspondence 18. Social activities 19. Leisure activities 20. Physical or sporting activities 21. Talking newspapers 22. Directories of services/information leaflets 23. General information on services. 24. Specialised housing for people with visual impairment 25. Low vision service committees

A Vision for London: Survey of services for adults with visual impairment living in London 89 Appendix 10: Questionnaire, short version

Mapping VI services across London Boroughs

Borough:

Position:

1. In your borough is there a hospital eye clinic?

Yes No

If yes; is there an information/advice service for patients with long term sight loss?

Yes No

If yes; is this provided by: (please tick one item)

 Voluntary sector  Local authority  PCT  Combination of the above  2. In your borough is there provision for low vision assessment?

Yes No

A Vision for London: Survey of services for adults with visual impairment living in London 90  Voluntary sector  Local authority  PCT  Combination of the above

3. In your borough is there a prescribing service for low vision aids?

Yes No

 Voluntary sector  Local authority  PCT  Combination of the above

4. In your borough, is there a service which offers emotional support to people with long term sight loss?

Yes No

 Voluntary sector  Local authority  PCT  Combination of the above

A Vision for London: Survey of services for adults with visual impairment living in London 91 5. In your borough is there a ‘one stop’ Low Vision Service?

Yes No

If yes; what services does it offer?

 Low vision assessment  Dispensing low vision aids  Advice and information  Rehabilitation  Emotional support

6a. How many VI Rehabilitation Officers are employed by the local authority? (please circle for full-time equivalent posts)

1 2 3 4 5 6 7 8 9

6b. Do any other organisations employ Rehabilitation Officers?

Yes No

If yes; how many? (please circle for full-time equivalent posts)

1 2 3 4 5 6 7 8 9

7. Does the local authority publish information, for example a directory on local services for people with visual impairment?

Yes No

A Vision for London: Survey of services for adults with visual impairment living in London 92 If yes; what formats are available:

 Hard copy standard print size  Hard copy large print  Braille  Audio  Web-site  Translation into language(s) other than English?

8. In your borough is there a benefits advice service for people with VI?

Yes No

If yes; who provides the service

 Local authority  Citizens Advice  A VI charity

9. In your borough is advice on housing available to people with VI?

Yes No

If yes; who provides the service?

 Local authority  Citizens Advice

A Vision for London: Survey of services for adults with visual impairment living in London 93  A VI charity

10. In your borough is there a service which offers advice and support to people with VI seeking employment?

Yes No

If yes; who provides the service?

 Local authority  Citizens Advice  A VI charity

11. What services are offered in your borough to families with children who are visually impaired?

 Advice to families at point of diagnosis  Low vision assessment  Prescribing low vision aids  Emotional support

Many thanks for your time and knowledge

John Harris, Chief Executive

Please send this completed form to:

John Harris, Metropolitan Society for the Blind,

A Vision for London: Survey of services for adults with visual impairment living in London 94 102 Bermondsey Street, London SE1 3UB

A Vision for London: Survey of services for adults with visual impairment living in London 95 Appendix 11: Questionnaire, long version

Mapping VI services across London Boroughs (For face to face interviews)

Borough:

Position:

1. In your borough is there any Sight Loss Prevention work possibly in partnership with health care professionals......

2. In you borough is there any Outreach Work to contact hard to reach groups......

3. In your borough is there a hospital eye clinic?

If yes; please give name of the hospital:......

4. Is there an service providing a low vision assessment for low vision aids, (magnifiers etc) in the hospital or community

If yes please name of hospital/practice ......

5. Is there an information/advice service for patients with long term sight loss at the eye clinic?

A Vision for London: Survey of services for adults with visual impairment living in London 96 If yes; please give contact details:......

6a. In your borough is there a ‘one stop’ Low Vision Service?

Contacts......

6. Is there a Low Vision Services Committee or local partnership group in your borough

Contacts......

7. How many VI Rehabilitation Officers are there (please circle for full-time permanent posts and indicate if they are for adults or children)

1 2 3 4 5 6 7 8 9

Contacts......

8. Is there a resource centre in your borough, displaying a equipment?

Contacts......

9. In your borough, is there a service which offers one to one support specifically for sight impaired people to assist with:

Contacts......

A Vision for London: Survey of services for adults with visual impairment living in London 97  Welfare Benefits checks  Welfare Benefits applications  Applications to apply for concessions for people with a sight impairment  Applications to local door to door transport  Reading correspondence & paying bills  Organisation of housing repairs  Moving to appropriate accommodation  Applications to join organisation that provide leisure activies, (Vocal eyes, Shape Tickets, RNIB Talking Books, Calibre etc)  Advice and information

10. In your borough, is there a service which offers the following specifically for people with long term sight loss:

Contacts......

 Social groups  Activities  Classes  Computer  Keep fit, blind bowls etc  Emotional support

11. In your borough is there a talking newspaper or talk magazine

Yes No Contacts...... A Vision for London: Survey of services for adults with visual impairment living in London 98 12. Does the local authority or VI charity publish information, for example a directory on local services for people with visual impairment?

Contacts……………………………………………………………………………

13. In your borough is there a service which offers advice and support to people with VI seeking employment?

Contacts......

14. Are their services are offered in your borough visually impaired children and their families

Contacts......

15. Is there a link in your borough to the local further education college for people with a visual impairment?

Yes No

16. Is there a service specifically for visually impaired people with learning difficulties in your borough?

Contacts......

17. Is there housing provision specifically for people with visual impairment in the borough:

A Vision for London: Survey of services for adults with visual impairment living in London 99 Contacts:......

18. Are there other organisations or services available locally used by those with permanent sight loss.

 Age Concern or other  Disability Organisation  Lunch clubs  Handyman service  Other services

Many thanks for your time and knowledge

Henrietta

Please send this completed form to:

Henrietta Doyle, Metropolitan Society for the Blind,

102 Bermondsey Street, London SE1 3UB

Or email it to me at: [email protected]

A Vision for London: Survey of services for adults with visual impairment living in London 100 Email copies of this report can be provided on request. Hard copies, including those in alternative formats will be charged at cost. Please contact:

Henrietta Doyle London VI Forum Development Worker Lantern House 102 Bermondsey Street London SE1 3UB

[email protected] 020 7378 0985

A Vision for London: Survey of services for adults with visual impairment living in London 101