Covid-19 measures and their relation to people with sight loss.
Contents:
· Introduction.
· Our requests.
· Equality.
· Accessing information.
· Digital technology.
· Social distancing.
· Changing environments are challenging environments.
· Employment.
· Education and schools.
· Attitudinal barriers and raising public awareness.
· Impact on mental health and wellbeing, loneliness, isolation.
· Support in the local community.
Introduction.
Upon ‘lockdown’ Wales Council of the Blind immediately gathered the Wales Vision Forum for weekly meetings to discuss what the sector was doing to address the restrictions imposed by our governments. Consequently, over a dozen meetings have been held to share concerns and new working practices so that WCB could maintain a web page giving the latest situation for the benefit of professionals and individuals. It was our intention that these meetings enable the sector to work collaboratively and to deliver information in the timeliest manner. This has been its great success. Also WCB, through the forum, assembled 22 local authority booklets (7) giving information on contacts and the availability of local support: optometry; volunteer deliveries; local sight loss charities and so on. These were distributed through the Welsh Local Government Association to each authority and to each contact - professionals and individuals - held by WCB on a county-by-county basis.
As ever accessible information is the key enabling factor for people with sight loss. The pandemic has put that into sharp focus; we hear that not enough services are making their information available in accessible forms, yet this is needed more than ever. WCB has continued to produce Sylw, its weekly e-bulletin and print / audio monthly, so that people are kept up-to-date with changes. It has also held a series or regional telephone meetings with its West Wales Forum to gather opinion there.
Therefore, to represent the broad range of views of people with sight loss, this document was made in consultation with Wales Vision Forum. Through this forum we consulted, or quoted, the following organisations:
Guide Dogs
Care and Repair Cymru
Macular Society
RNIB Cymru
International Glaucoma Association
Blind Veterans
Welsh Rehabilitation Officers Forum
North Wales Society for the Blind
Vision Support
Sight Cymru
Sight Life
Visual Impairment Merthyr Tydfil
Ceredigion Association for the Blind
BridgeVis
Carmarthen Area Blind Society
Pembrokeshire Blind Society
Radnorshire Association for the Blind
Visual Impairment Breconshire
Vision Impairment West Glamorgan
We have also consulted our own focus groups in West Wales.
OUR REQUESTS.
+ It is essential that Local Authorities, and others delivering services such as transport, shopping centres, leisure centres and so on, consult local Disability Access Groups and other disability advisors to ensure the old access errors are not reintroduced under the cloak of expedience.
+ Service providers in the Third Sector have experienced a much higher demand on telephone support services. The lockdown measures have forced a revised way of working for many charities and support services whereby home working has resulted in staff being deployed into telephone support work. However, this has set up an expectation amongst clients for a service that may be unsustainable as ‘normal’ work practices resume. Third Sector organisations are therefore concerned about what funding is available to continue these services. Indeed, funding has proved hard to get under the present measures, resulting in material threats to the very existence of the organisations delivering such services. There are likely to be cost savings with telephone and online emotional support that would take pressure of social care services in the long run. They are worth investing in.
+ As explained below, the demand for rehabilitation and mobility support will be huge as we emerge from ‘lockdown’ and the environment is being reconfigured. As the inevitable waiting lists grow, the cases become more complex. What funding shall be made available to expand the already stretched rehabilitation services across Wales? And how can the demand for the services be met? Failure to provide ways to reorientate people with sight loss to the changed towns and cities will create a disproportionate impact on their independence and wellbeing, particularly at a time when Covid-specific services are being withdrawn, such as volunteering networks. A possible solution is to include the role of the rehabilitation officer within the Apprenticeship Levy within Wales, as is the case in England. This will enable Local Authorities’ workforce planning.
+ Any cuts being made as a result of the economic impact of the pandemic should not disproportionately affect disabled people. Indeed, there is likely to be a need to positively channel funding towards services that empower disabled people such as rehabilitation and local third sector support, and towards independence-enabling features such as accessible information and signage. This is so that disabled people are not excluded from the reintroduction of services.
+ Remember that information for disabled people does not stop at accessible forms of general public information – it must include information about the disabling barriers that temporary measures have introduced, where they occur and what the impact would be on Disabled people. Changed routes, for example, create problems for people with sight loss that are non-existent for sighted people. This is additional information.
EQUALITY.
One
thing is certain, the response to the Coronavirus pandemic has
brought inequalities to the fore. Despite decades of work to break
down disabling barriers in society we find them still evident in
some aspects of public life and even reappearing by the back door
as society implements rapid adjustments to service delivery and the
built environment. Therefore, the guiding principle of this
document is to stress the importance of not letting our guard down
on equality when the situation risks it being conveniently
ignored.
People with sight loss must not be the last to benefit from the reintroduction of services. This is an equality issue. Public and commercial sector authorities have a duty under the Equalities Act to deliver services that are as equally accessible to disabled people as they are to non-disabled people. Any guidance issued to these sectors must stress the importance of the Act to ensure that public information and adjustments to the environment are designed in a way that gives disabled people the fullest opportunity to enter the newly-configured services on an equal footing.
For this to happen, disabled people – including people with sensory loss – must be consulted meaningfully at the earliest opportunities. For example, Equality Impact Assessments must only be undertaken where input from disabled people is assured.
ACCESSING INFORMATION.
Public information on Covid-19 and the perceived health risks to people with sight loss.
‘I’ve got a hospital appointment but I’m worried about how to get there safely.’
First of all, there needs to be clear, non-alarmist messages going out about health risks. There is a lack of robust data that is currently forcing emergency measures that are likely to be incommensurate with the actual risks, particularly when compared with the risks emerging from the side-effects of the lockdown and social distancing measures: mental health, loneliness and isolation, unemployment, poverty, and health inequalities. Many disabled people are afraid to leave their homes and, coupled with precautionary measures by health workers and social care workers, are not getting the support they need for healthy and independent living. An RNIB impact paper (1) quotes a service user:
‘Will it become a choice of starvation or corona as we can’t leave our homes? I live on my own and cannot ask others to jeopardise their safety by getting my shopping.’
The majority of people with sight loss are, statistically speaking, in the age group (over 70) and therefore most at risk of the ill effects of Covid-19. Also, individuals in this age-group are most likely to be isolated and in need of additional care and support. It is essential, therefore, that the information given to them is in an accessible format so that they are properly informed about developments as they arise, including any changes to the official guidance on the coronavirus risks.
Do not rely on digital communication alone. Many people with sight loss do not have access to the internet or find the information there often to be inaccessible. However, recognising that online information is timelier than door drops, the websites must be accessible, clear, and well-organised.
Other information.
It is important to impress upon service providers - be they local authorities, other public bodies or owners of commercial facilities – that they have a duty to provide equality of service under the Equalities Act and must ensure, therefore, that any instructional information be provided in an accessible form for all disabled people. We are concerned that there will be new prescriptive pathways through buildings and public spaces that could arise in collisions or more serious accidents due to a blind person, for example, being unaware of instructions. This could arise in legal complications where the blame could be apportioned to the venue, so it is in their best interests to heed the Act. Therefore, accessible information and a thorough public awareness-raising campaign are crucial to ensure the venue reduces its liabilities in this regard.
As services and spaces are reintroduced for public use, the information provided at them, and about them, must ensure that people with sight loss are fully informed of changes that impact on their prior knowledge of - and familiarity with - the service. Information on changes to pathways, roadsides, ingress and egress from shops and so on must be available in accessible formats. Also, this information would ideally be available on the service’s website so that people are able to approach the service informed and confident.
Accessible information must be accurate as well as accessible. For example, people need to now that there are now safe ways to access optometry practices. Information such as this will help people immeasurably, but only if it is accurate.
It is important to consider that information for disabled people does not stop at accessible forms of general public information. As can be seen below, additional information must be provided specifically to people with sight loss as they require a better knowledge of what changes have taken place to environments and services in order to increase their confidence to enter such environments and take up services. This is information that sighted people obtain directly through markings, signage and notices. People with sight loss need much more prior information to know how to work in an environment that has changed from the one they had taken great pains to understand previously.
‘The layouts of the shops have been altered to allow for one-way systems making my usual shopping more difficult. I often forget items whilst shopping so go back on myself which you are unable to do now. I also struggle with being very aware not to pick up too many items to take a closer look at with my magnifier.’
DIGITAL TECHNOLOGY.
Guide Dogs Cymru made
the following observations: “In the ‘keeping in touch’ calls we have made to
all our clients, digital exclusion is a major concern. People
with sight loss need specialist software to access computers and
support to learn how to use it. Teaching somebody with sight loss
requires knowledge of such software, and so mainstream provision in
the community does not meet this need.
“All of these technologies need a great deal of support to learn and involve the purchase of equipment. If technology is to significantly improve the lives of people with sight loss, and reduce loneliness and isolation, it needs far more resources in terms of financial support and expertise to enable users to be fluent and comfortable in its use. It is absolutely the case that many programmes designed to increase digital inclusion lack these resources and fail to take this into account. There are unique challenges which need long term sustainable funding to build knowledge and confidence among people with sight loss, rather than one off pots of funding which are time limited and fail to recognize the complexity of the challenge.”
Many services are relying on alternative ways of serving individuals through online meeting platforms and traditional telephone methods. Social and support groups, for example, have used such methods to continue their programme of meetings. Also, traditional support from rehabilitation officers has been curtailed and a stop-gap of telephone wellbeing checks has been carried out in its place.
While there is a perceived need to prohibit conventional contact, we must not regard this as ‘the new normal’. There are barriers for many people in the adoption of communications technology for interaction, particularly amongst disabled and older people. What may seem natural to non-disabled people in active, office-based employment might be totally alien to many people. New communications technology should not be defaulted as the convenient alternative or an assumed norm; new technology is fraught with difficulties and complications, not least the cost of access equipment and the variable availability of broadband across Wales.
However, where such meetings are unavoidable, we must assure that they are as accessible as possible. Wales Council of the Blind is working with Wales Council for Deaf People on guidance for accessible virtual meetings. This will be distributed shortly.
SOCIAL DISTANCING.
‘I really do not know how I personally would cope with social distancing, as I cannot go anywhere for which I do not have an established mind map, and I am most likely not see not see other folk who are about.’
‘Social distancing is difficult if out on my own. I do not have a very good depth perception therefore do not realise I am too close to someone whilst in a supermarket.’
‘I was always so confident getting out and about with my guide dog. I am very concerned about this 2-meter distancing though now. My dog doesn’t understand social distancing so how will that work?’
Some observations about social distancing are at the Guide Dogs website: https://www.guidedogs.org.uk/news/Social-distancing-and-sight-loss]. See also (2) below.
‘Social distancing is the most challenging aspect for me in the whole Covid-19 situation. Not being able to socially distance is a major challenge to my independence and keeping myself safe.’
‘My guide dog hasn’t been trained to social distance, that’s why we need help from the sighted public.’
- Guide dog owners.
Blind and partially sighted people report that sighted people also need to observe the distancing rules. This is not always happening, putting the individual at a disadvantage through not knowing how close the sighted person is.
CHANGING ENVIRONMENTS ARE CHALLENGING ENVIRONMENTS.
‘It can be really challenging at the best of times when you can’t see what’s going on around you. At the moment, it’s vital that I get more verbal information from people around me, as a lot of the environment around us is built on visual cues, which I can’t rely on.’
‘I have no idea what 2 metres away looks like. I am worried I will never leave the house. I won’t be able to keep away from people and as I don’t look ‘blind’ people will not know to keep away from me. I have a little usable vision but can't judge distance. If I have to rely on bollards or new road markings, I will not see them, it’s such a worry for me.’
Any familiarity with the physical environment will largely be undermined by the changes being made to routes through shops, streets and parks to enable physical distancing. Rehabilitation and mobility officers will play a key role in re-training people with sight loss to navigate once-familiar routes, now made unfamiliar due to the re-organisation taking place throughout the country. The Welsh Rehabilitation Officers Forum reports that all assessments for new rehabilitation clients have been conducted over the phone. This creates an illusion of reducing waiting lists because people are swiftly placed into active case lists where rehabilitation is assessed as necessary. However, the outcomes identified in the assessments will not be achieved because the worker is unable to carry out the rehabilitation programme. Consequently, a backlog of work is being created with the risk of inadequate temporary measures being adopted as a stop-gap in the meantime. People are relying on carers and family members delivering the informal support and this can both form bad habits and create a culture of dependency.
Shops and shopping.
‘I don’t always know there is a queue because my dog takes me to the door of the shop, not the end of the queue. Shops have introduced visual indicators and one-way systems and if you can’t see they’re a major challenge.’
‘The shopping has been left to my husband as I find it a
little difficult and my confidence has decreased. This really
does make me cross with myself but I do understand that this is
necessary.’
‘I was always so confident getting out and about with my guide dog. I am very concerned about this 2-meter distancing though now. My dog doesn’t understand social distancing so how will that work?’
‘I can’t work out where to queue.’
‘As someone with a visual impairment, it has become quite difficult to food shop. I struggle with staff on the door of the shops calling you in when hand gestures are used.’
The ‘sunflower lanyard’ used in Tesco to indicate that the wearer may need some assistance is controversial, partly because it reinforces a perception of dependency. Nevertheless, it has proved useful for some people because, even if the public do not understand its purpose, staff do, and can act on it.
Guide Dogs has produced guidance for shopkeepers (3)
Transport and roadways.
‘I am normally a very confident shopper on my own but since lockdown I can’t get to a shop as I will not travel on public transport and find the whole thing quite difficult.’
‘I feel I’ve lost my independence forever, I used to enjoy getting on the bus and coming to the Sight Life coffee morning and other groups. I just wouldn’t feel safe using public transport. Thank goodness for their telephone groups, at least I can still chat to people this way, it’s just not the same as seeing someone in person.’
- Sight Life service user
People with sight loss told Guide Dogs that concerns about travelling once lockdown restrictions begin to be lifted included their ability to social distance whilst using transport (84%) and access to support whilst using transport (61%).
Public transport will pose severe difficulties for people with sight loss. Many people do not feel confident that they’ll get the support they need from others when using trains and buses. Measures such as putting crosses on seats are not helpful for sight-impaired people and can prompt altercations with other passengers. If such indicators are to be used, they must be consistent.
Some towns and cities are introducing one-way systems for pedestrians by painting a white line to create lanes to follow. Coupled with this are areas marked out for outdoor eating areas to enable cafes to start taking customers. How are these measures being made accessible for people with sight loss? The traditional method of a white cane user following the edge of a building may not be possible if it means going against the marked direction or if the area closest to the building is now being set aside for tables and chairs.
RNIB has produced a checklist of considerations regarding inclusive journeys (4).
EMPLOYMENT.
‘For those in employment there are real worries that extra safety measures for their needs will be overlooked.’
- Guide Dogs
The health-centred focus of the adjustments made to society has taken attention away from the impact on the hard-won jobs people with disabilities hold. With unemployment in Wales doubling, people with sight loss seeking employment will find themselves further disadvantaged. With less than 25% of blind and partially sighted people of working age in work, employment schemes that support people back into work must be inclusive of people with sight loss, as must the measures employers are putting in the workplace to address Covid-19 concerns. It should also be noted that projects supporting disabled people into work will also face huge challenges as disabled people will need to access these in order compete in an even tougher environment.
It is important that Welsh Government holds the Access to Work scheme accountable during the return to work. The Cross Party Group on Disability reported that, during the lockdown, Access to Work has not processed any new claims for disabled people and the whole department has been moved to deal with Universal Credit applications. It is critical that Access to Work reviews how, as an invaluable scheme for disabled people in work, it supports people with sight loss to return to work, taking into account a change in working environment and potential unfamiliarity in relation to travel. Use of public transport and social distancing will mean that, for many people, returning to the office will be impossible without reviewing the fares to work scheme, as previously familiar routes could now be unsafe. Consideration of social distancing will also have to be taken into account in relation to using a support worker / driver. We suggest that Access to Work consults on potential changes to the scheme with disabled people at the earliest opportunity.
Access to Work customers have been able to submit claim forms for reimbursement without an employer or support worker signature and ask their line manager or support worker to provide an email confirming the details of the claim and that they agree to the terms and conditions on that form. This has been welcomed but we have been informed by the Access to Work scheme that there has been no change in their guidance in relation to COVID-19. For many people returning to work these can be anxious times:
‘I have always used public transport to get to work because I use a familiar route. But I contacted the scheme to ask if there were any changes to fares to work as, with social distancing and changes to the layout on the bus and train, the journey is no longer familiar and I didn’t feel safe. I was told that unless there is a medical reason why I can’t use public transport it would be my choice not to use public transport and will have to pay for a taxi myself.’
This could put an increased financial burden on those returning to work. We would like to see Access to Work review such cases on an individual basis and with an awareness of the devastating impact Coronavirus has had on the independence of people with sight loss. We would like to see Access to Work aligning their guidance to the social model of disability and not the medical model suggested in the above response.
WCB published a report How Accessible is Access to Work for people with sight loss in Wales? 3 years on:
http://www.wcb-ccd.org.uk/single_post.php?var=1844
None of Access to Work’s functions are devolved to Wales. However, Welsh Government in its aspiration to increase the number of disabled people in employment could play a role in influencing change and improvement, as detailed within this report. We do not want to see people with sight loss further disadvantaged at this time.
We would like to see information about the Access to Work included within the resource on responsibilities as an employer:
https://gov.wales/your-responsibilities-employer-coronavirus
EDUCATION AND SCHOOLS.
As with employment, we are risking losing our grip on a key equalities issue as the general public re-enters these domains. Again, this crisis has highlighted the disabling barriers people face and has given us a sharp reminder that hard-won battles are easily lost when the landscape changes so radically. Here are some thoughts on barriers children with sight loss face, pending a fuller consultation on the situation.
Habilitation: Social distancing within the classroom is a concern for many children and young people with sight loss. It is even more essential that children with sight loss have access to habilitation services where changes to the school layout could affect their mobility.
Digital inclusion in education: There is a concern that not all children have the right equipment and tools for learning at home. Is the equipment they have right for them? Also, is the work being sent home fully accessible? Welsh Association of Vision Impairment Educators (WAVIE) have heard of PDF files being sent that cannot be accessed using screen readers, for example.
Blended learning should not give way to screen-based learning alone, which can lead to fatigue, but consider the broader styles and modes of learning. Provision of resource packs is essential to achieve this.
Schools must audit their digital skills and learning materials and determine how accessible these resources are for children with sight loss. In achieving this there must be closer working with all services, schools and specialists.
It is also critical that teaching assistants are provided with equipment that enables them to work remotely with children with sight loss. We must focus on the child and the support they receive from teaching assistants.
There is a risk of a single-minded approach that further excludes vi children. We must do all we can to ensure that access to education is accessible to all.
ATTITUDINAL BARRIERS AND RAISING PUBLIC AWARENESS.
‘I’m less confident getting out and about than I was. Now that lockdown is lifting, other people are trying to get their life back to what it was, but it’s a whole new world for people with sight loss. It’s a lot for us to adjust to and it would really help if people have an awareness of how they can play their part.’
While the general public is being made fully aware of the ways to
maintain physical distance from others, people with sight loss may
not be able to access the information that makes distancing
possible. This has a knock-on effect of making the general public
antagonistic towards those of us who appear to be breaking the
rules. This is largely a matter for public-awareness campaigning
such as the Guide Dogs ‘Be There’ campaign.
An example of public ignorance of the difficulties guide dog users face with social distancing is related on the ITV website (5).
WCB was asked by the sector to produce Wales-wide online information and booklets for professionals and individuals (7).
IMPACT ON MENTAL HEALTH AND WELLBEING, LONELINESS, ISOLATION.
‘The well-being of everyone must be the guiding principle. To ensure equality the aim should be that people with sight loss have the same independence, choice and control as everyone. The experience of people to date indicates that there is plenty of room for improvement.’
- Guide Dogs.
‘There is considerable evidence to show that people with sight loss are at greater risk of mental health issues, isolation, and loneliness.’(6)
‘The importance of touch and human contact is crucial to people with sight loss. Individuals with visual impairments often rely heavily or even solely on physical guiding and feeling the physical world around them. With a large part of these ways of communicating potentially being removed, there is likely to be an increased feeling of loneliness and isolation amongst people with sight loss, potentially leading to a decrease in wellbeing and mental health.’
-Sight Cymru briefing note (7)
There is a real threat to a blind or partially-sighted person’s independence and confidence as the lockdown is eased. Disabling barriers are being created whenever badly planned or inaccessible adjustments are made to the usual pathways and milling areas. These create inequality in the easing process and may result in longer-term problems for disabled people that could affect their wellbeing and mental health.
Guide Dogs mentions feedback from service users of well-being
issues with more about low mood and depression. There have been
several references to low levels of self-esteem.
It is worth noting that all regional, local and national organisations have been conducting telephone wellbeing checks with their service users. There has been a considerable increase in telephone befriending requests and volunteers. There is a concern that these volunteers will drop off as people get back to work.
‘Macular Society rang me after a telephone group meeting and we had a long conversation about why I was feeling low and she put me in touch with a counsellor. I was floundering and I still am. Being in lockdown is getting worse. I’ve got no family, one or two of my friends I thought were there for me, I’ve not heard from them. I was just struggling. The counselling was a tremendous help … I could tell her anything, everything. I could scream, cry down the phone it didn’t matter. There are very few people I can do that with.’
SUPPORT IN THE LOCAL COMMUNITY.
Community support from local societies and groups for blind people, as well as other voluntary groups, has been crucial in keeping people in isolation safe and well by delivering provisions of all kinds to those unable to get them for themselves. As the various measures are eased or otherwise modified, there will be more people returning to work. This will have an impact on the availability of volunteers to carry out tasks such as shopping and obtaining medicines. It is important that community groups, particularly those that have been formed as a response to the pandemic, maintain a public front (through social media and door drops) so that the status of their service is made known.
There are Community booklets giving contact details in each local
authority for various kinds of voluntary support (7).
References:
(1) RNIB - Letter to Mark Drakeford, First Minister, 16 June 2020.
(2) Guide Dogs’ ‘Be There’ campaign gives guidance to encourage the public to feel confident in their ability to offer support whilst maintaining social distancing.
(3) Guide Dogs’ guidance for shops: https://www.guidedogs.org.uk/about-us/what-we-do/research/Policy-and-guidance-for-businesses/Guidance-for-shops
(4) RNIB Inclusive Journeys guidance https://www.rnib.org.uk/campaigning/priority-campaigns/inclusive-journeys:
(6) Covid-19: Henshaws survey with blind and partially sighted people. A final report on survey findings, June 2020.
(7) Community Support booklets at http://www.wcb-ccd.org.uk/coronavirus/word_documents.php
(8) Sight Cymru – Briefing on Covid-19 and people with sight loss.