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CVI Explanatory notes2011117125744 by dfsiopmhy6


									The identification, referral and registration of sight loss:
Action for social services departments and optometrists, and
explanatory notes

 This document is written for both optometrists and social services as there is much
 information in common. However, you may wish to focus on these sections:

 Optometrists       Background
                    Low Vision Leaflet (LVL)
                    Certificate of Vision Impairment (CVI)
                    Development and management of the LVL, RVI and CVI

 Social service Background
 departments    Referral of Vision Impaired Patient (RVI)
 (SSDs)         Certificate of Vision Impairment (CVI)
                SSD response to the LVL, RVI and CVI


1. Following extensive consultation, significant changes have been made to the system
   for identifying people with serious sight problems. This will enable them to gain more
   timely access to specialist help, and registering those who meet the criteria.

2. The main aims of the revision are to:
               improve the speed of referral for social care;
               increase the quality and type of information provided;
               improve the accessibility and understanding of the process for patients,
               update the terminology in line with consultation findings.
   The gathering of epidemiological data has also been overhauled.

3. From November 2003 three new documents were introduced, the:
             Letter of Vision Impairment (LVI): a self-referral letter for optometrists to
             give to people who present to them. From September 2005, this will be
             replaced with the Low Vision Leaflet (LVL).
             Referral of Vision Impaired Patient (RVI): a referral for eye clinics to
             send to social services as needs arise.
             Certificate of Vision Impairment (CVI): a certificate establishing eligibility
             for registration as either sight impaired (partially sighted) or as severely
             sight impaired (blind).

4. The three documents have all been developed in consultation with: service users;
   academics; the Association of Directors of Social Services; Department of Culture,
   Media and Sport; Department for Work and Pensions; Inland Revenue; National
   Assembly for Wales; Northern Ireland; College of Optometrists; RNIB and various other
   voluntary organisations; Royal College of Ophthalmologists; Scottish Executive; social
   workers and specialist rehabilitation workers. They have been revised in the light of
   stakeholder’s comments & re-issued in August 2005.

5. These notes explain the function of each document and outline the roles of social
   services departments and optometrists in implementing and managing this system.
CVI, LVL and RVI: Explanatory notes for SSDs & optometrists (Last updated: August 2005)       Page 1
Low Vision Leaflet (LVL)

6. The LVL is a self-referral leaflet, which a person who encounters problems resulting
   from sight loss can send to SSDs if they wish to be contacted for help. It is important
   that the LVLs provided should be of a high standard, in terms of legibility and quality of
   reproduction, to ensure they are suitable for display. A sample LVL is available only in
   electronic, downloadable form. SSDs should download the template from:,
   (click on 'Identification and Notification of Sight Loss') and tailor it for local use.

7. The document should be opened as ‘read only’, saved with a local file name. This can
   then be tailored to meet local needs before SSDs supply copies to optometrists for
   onward distribution to any patients they encounter who have serious sight problems.
   The content of the template is self-explanatory and should not be amended in
   developing the customised version.

8. Social services should tailor the LVL with the appropriate address to which people
   should send the leaflet. They should also add contact details of local sources of
   information and advice that patients can call upon, whether or not they choose to refer
   themselves for an assessment of their social care needs at that stage.

9. SSDs should consult with a range of sight-impaired people on the types of information
   they believe people with failing sight would find helpful. They may also find it helpful to
   liaise with local organisations with regard to any additional content for the leaflet.

10. Optometrists / opticians or practice staff should encourage appropriate patients to take
    and complete an LVL. Such clients might include those whose difficulties cannot be
    optically corrected and who are experiencing problems with things like reading,
    crossing the road or cooking.

11. People with sudden visual loss often go to an optometrist rather than their GP, which
    may result in an emergency referral to the hospital eye clinic. The optometrist may use
    this occasion to give the person an LVL, enabling him or her to self-refer to social
    services and/or contact the sources of advice and support included in the leaflet,
    should they wish to do so.

12. A person may choose not to use the LVL to self refer for social care. Further
    opportunities to be referred will arise at any appointment in the eye clinic, when the RVI
    can be used, or when and if a CVI is completed.

Referral of Vision Impaired Patient (RVI)

13. Staff in the hospital eye service may issue an RVI to refer a patient (with their consent)
    for a social care assessment. This should be done as soon as social needs become
    apparent, but where certification is not currently appropriate or cannot be carried out,
    for example if they are not being seen by a consultant.

14. Social needs include the need for information about community services for vision
    impaired people, emotional support, practical advice and rehabilitation training. The
    SSD will particularly wish to be alerted to any specific concerns about potential risk
    factors or where employment or education may be threatened.
CVI, LVL and RVI: Explanatory notes for SSDs & optometrists (Last updated: August 2005)          Page 2
15. It would be good practice for hospital eye clinics to assume that social services have
    not been alerted to the person’s problem, and to act accordingly.

16. The RVI is only available in electronic, downloadable form. Hospital eye services are
    able to download it from the NHSweb at:

17. It can be obtained by those who do not have access to NHSweb at:
    (click on 'Identification and Notification of Sight Loss').

18. Clients may be entitled to a social care assessment and services from the local
    authority or its agent without registration. However, they should not be placed on the
    formal register in the absence of a CVI form.

19. Some eye clinics deal with people from a wide catchment area and a number of
    different social service departments. SSDs and local eye clinics should liaise over the
    correct address(es) to which the RVI (and CVI) forms should be sent, and over
    arrangements for forwarding documentation to other councils if necessary.

20. The RVI has been introduced to speed up access to social assessment and care in the
    early stages of serious vision impairment, and therefore speed of completion and
    transmission are key.

Certificate of Vision Impairment (CVI)

21. The CVI performs the same function as the BD8 did. That is, it formally certifies
    someone as partially sighted or as blind (now using the preferred terminology ‘sight
    impaired’ or ‘severely sight impaired’, respectively) so that the local council can register
    him or her.

22. Clients are entitled to access services they are assessed as needing without
    registration, but should not be placed on the formal register on the basis of an LVL or
    RVI only. The signature of a consultant ophthalmologist certifying eligibility to be
    registered is required on a CVI before registration can be offered. Registration is
    voluntary but may entitle people to various benefits and concessions.

23. The CVI also acts as a referral for a social care assessment if the person has not
    previously been brought to the attention of social services as someone with needs
    arising from an impairment of vision.

24. An additional purpose of the certificate is to record a standard range of diagnostic and
    other data that may be used for epidemiological analysis. Action in relation to this lies,
    and will continue to lie, with hospital eye clinics.

25. Hospital eye services will replace form BD8 (1990) with the form Certificate of Vision
    Impairment (CVI) from 1 September 2005 and SSDs will need to be aware of this as
    BD8s will no longer be accepted.

26. The CVI is only available in electronic, downloadable form. Hospital eye services are
    able to download it from the NHSweb at:
CVI, LVL and RVI: Explanatory notes for SSDs & optometrists (Last updated: August 2005)            Page 3

27. A sample version can be viewed by those who do not have access to NHSweb at:
    (click on 'Identification and Notification of Sight Loss').

28. Circular HN(90)5; HN(FP)(90)1; LASSL (90)1, dated January 1990 which relates to
    form BD8(1990) is hereby cancelled.

Payment for signing the certificate
29. Those consultant ophthalmologists for whom it is part of their terms and conditions of
    employment are paid a fee for certifying patients. Councils should not be involved in
    this process as such payments are the responsibility of the local health service. If more
    detail on these payments is needed please see Explanatory Notes for Consultant
    Ophthalmologists and Hospital Eye Clinic Staff which is available from the same

SSD response to the LVL, RVI and CVI
30. Apart from the element of formal registration, eligibility for which is certified by the CVI,
    all three documents are designed to act as referrals to social services. They need to be
    handled within the local procedures for other referrals. It may be unwise to set up a
    system that directs all vision-related referrals to a specialist team as, with training of all
    front-line staff, some of the initial contacts may be resolved without engaging
    rehabilitation worker time.

31. Whatever referral route (CVI, RVI LVL) is used, level of need will be the key
    determinant of urgency. If a person is assessed at significant risk either because of
    their own health and safety or their ability to manage daily routines or they have
    difficulties in discharging their responsibilities for a child(ren) under 18, then a
    telephone referral to social services may be required.

32. The documents have been designed to be self-explanatory as far as indicating the type
    of response that the individual client may require. However, councils may consider that
    training local eye clinic staff and optometrists to understand better the processes
    involved, including the implications of Fair Access to Care, may improve the quality of
    the information provided by the eye clinics.

33. It would be good practice for councils with social services responsibilities, or their
    agents, to use the current Performance Indicators that apply to new older clients. This
    would include:
         Best value performance indicator 195: that the time from first contact to the
         beginning of assessment should be less than or equal to 48 hours.
         Best value performance indicator 296: This concerns the acceptable waiting
         times for care packages. That is, following the completion of assessment all
         services in the care package have been supplied within 28 days. If this “package”
         includes a rehabilitation programme then this should be well underway (at least
         two sessions) with no planned interruption prior to its completion.
         In the case of the CVI only, the person’s inclusion on the local authority’s register
         (with their consent) and for them to be issued with a standardised registration
CVI, LVL and RVI: Explanatory notes for SSDs & optometrists (Last updated: August 2005)              Page 4
34. Information and templates for the ADSS approved registration card design were
    published in March 2004 as part of a series of good practice materials being produced
    by the Improving Lives coalition. The document is available from:

35. The ADSS indicates that the initial contact should be within 10 working days to
    establish the urgency of the need and to give information about statutory and voluntary

36. Date of registration equals date of certification. SSDs should note that when adding a
    service user to the register, the department or its agent must record the date of
    registration as the date on which the person’s eligibility to be certified was established.
    This date is clearly noted on the CVI, and can have significant implications for the date
    from which benefits may be paid. This date should also be the one that is entered onto
    the registration card issued to the service user.

Development and management of the LVL, RVI and CVI

37. Responsibility for downloading, customising and distributing copies of the LVL to
    optometrists / opticians rests with social services (paragraphs 7 – 10). This should
    ensure the LVL will be available for opticians/optometrists to give to appropriate people
    (paragraphs 11 – 12).

38. It is likely that local services, procedures and contact details will change over time.
    Therefore the LVL should be reviewed regularly to ensure the contents continue to be
    appropriate. SSDs should ensure that there are agreed systems so that stocks of LVLs
    are available to optometrists.

39. Hospital eye services have responsibility for downloading the template RVI and CVI
    from the NHSweb. Once saved these will be tailored with the hospital’s logo and/or the
    clinic contact details.

40. Some eye clinics deal with people from a wide catchment area and a number of
    different social service departments. SSDs and local eye clinics should liaise with each
    other over the correct address(es) to which RVIs and CVIs should be sent and over
    arrangements for forwarding referral letters and certificates to other councils if

Information requirements

41. These changes do not require social services departments to collect any new data,
    though good practice would indicate that simple local monitoring systems should be put
    in place for all three documents. The council will need information on the number of its
    visually impaired clients for service planning purposes, for example. It is possible that
    the Department of Health will seek to evaluate the take up and effectiveness of the new
    system in the future.

42. SSDs are still required to submit returns on the numbers of people registered within
    their authority.

CVI, LVL and RVI: Explanatory notes for SSDs & optometrists (Last updated: August 2005)           Page 5
Transferring and retaining the CVI

43. The CVI is an important source of information for council services and if a person
    moves to another area, it should be transferred from the old to the new SSD. This will
    avoid the need for re-certification. Normally it will be the role of the SSD in the area to
    which the service user has moved to request the form, when they are advised that this
    has occurred. The new SSD should then issue the service user with a replacement
    registration card.

44. The social services’ copy of the CVI should be kept until transferred to another
    authority or until there is evidence that the person has been deceased for at least 3
    years. This is because of the need to establish if a deceased person was registered,
    due to the tax implications.

Additional information and enquiries
45. Background information concerning the changes to the identification, notification and
    registration of sight loss can be found at

46. Address enquiries, preferably by email, to:

   Policy Management Unit (4)
   Older People & Disability Division
   Area 120, Wellington House
   133–155 Waterloo Road
   London SE1 8UG

CVI, LVL and RVI: Explanatory notes for SSDs & optometrists (Last updated: August 2005)           Page 6

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