THE COST OF SIGHT LOSS IN THE UK CAMPAIGN

PSYCHOANALYTIC COUNSELING A MOMENT’S INSIGHT IS SOMETIMES
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The cost of sight loss in the UK: Campaign report 23

“Prevention, raising awareness, early detection and treatment could both reduce spending and save sight”

Contents

Executive summary

Introduction

Methodology

Eye health costs

Independent living costs

Social services

Disability benefits

Transport and mobility

Education and training

Employment services

Costs to the voluntary sector

Informal care

Costs to the private sector

The cost of unemployment

Conclusion

References


Acknowledgements

I would like to thank all those who have contributed to this report, from initial advice on the research through to comments on the final draft. I would in particular like to thank Professor Sir Tony Atkinson and Professor Alastair Gray for their interest and guidance whilst working on this project at Nuffield College. My thanks also to Fazilet Hadi and Sophie Summerfield at RNIB for their input.


This research has been supported by RNIB, Nuffield College, Oxford and an unrestricted educational grant from Novartis Ophthalmics.


Steve Winyard,

RNIB Public Policy Department


Executive summary


This report provides the first prevalence based estimates of the economic and social costs of vision loss for the United Kingdom. It is based upon detailed expenditure data for 2001/2, assembled from central government, local government, voluntary sector and private sector sources. It indicates that the total cost of sight loss is in the region of £4.9billion a year.


The report contains a powerful message and a warning. Although sight is the sense we most fear losing, as a society we spend relatively little to prevent, detect and treat eye disease – in total around £1.2billion. This represents just 1.6 per cent of the total NHS budget. Typically eye health services are overloaded and under-resourced:





Government also spends relatively little to support independent living by those with sight loss – in total around £1.1billion. Key services such as rehabilitation, social support, community equipment, disability benefits, and accessible transport are generally under-funded and under-developed.





In the absence of adequate statutory services for blind and partially sighted people, it is left to family and friends to provide the support necessary for independent living. This informal support costs some £1.5billion and covers a wide range of activities including help in the home, reading mail, shopping, gardening and the provision of door to door transport. Overall this is ten times greater than the expenditure by local and central government on social care.


A final £1billion is the cost of productivity loss in the economy due to the much higher unemployment rate experienced by blind and partially sighted people. Currently three out of four are not in paid employment, a figure that has not changed significantly over the past decade. This represents a major loss to society in terms of the output foregone. It also explains the poverty and social exclusion experienced by many blind and partially sighted people of working age.


This figure of £4.9billion is a conservative one.





In the UK, successive Governments have failed to recognise blindness as a severe disability. As a result in far too many areas we have unsatisfactory and under-funded services. Additional expenditure is urgently needed on low vision services, community care and equipment, disability benefits, transport and employment support. Properly funded and timely services in these areas would make an important contribution to improving the quality of life of blind and partially sighted people.


If central and local Government did provide quality services across the whole of the UK, public expenditure would inevitably rise. However targeted expenditure on four areas could help to reduce the overall cost to society of sight loss and save sight:






And finally the warning. Demographic change and improvements in health care are leading to an increasingly elderly population and longer life expectation. It is estimated that the population in the over 60 age group will increase by 24 per cent by 2020. The increase in the over 80 age group is sharper still. Given that sight problems are experienced predominantly by older people, this will mean a dramatic increase in demand for services to prevent and treat eye disease. With the incidence of visual impairment projected to rise by around 35 per cent by 2020 (1), there will also be a big increase in the demand for services to support independent living. The planned expansion of services must start now with the provision of significant additional funding running to at least £420million a year.


In the case of primary and secondary eye care, the modernisation of services, including the specification of new pathways, will help. But alone this will not deliver the improvements that are so urgently needed. There is a major funding gap that must be addressed by Government in England, Wales, Scotland and Northern Ireland.




Introduction


What are “the costs of blindness”? This question has become of increasing importance in recent years to organisations representing blind and partially sighted people. As we have campaigned for improved access to a range of services and benefits, it has become clear that we need to measure accurately the costs to the individual and to society of sight loss.


To date, work in this area has focused largely on the costs faced by the individual. That is, research has been concerned with the identification and quantification of the extra costs faced by disabled people (4,5). With regard to sight loss, RNIB and the University of York used focus groups to identify and explore the main areas of additional expenditure faced by visually impaired people at the different stages of their life. This was published as “The Costs of Blindness” (6) and further work to quantify these costs has undertaken by the Disability Benefits Consortium and the University of Loughborough. This is due to be published in September 2004.


Research focusing on individual costs is important in that it allows us to assess the adequacy of additional cost benefits such as Disability Living Allowance (DLA) and Attendance Allowance (AA). By identifying the breadth and depth of impact of sight loss on the individual and their family, we also provide confirmation of blindness as a severe disability.


Of increasing importance is research into the costs faced by Government and the wider society when someone loses their sight. As we have campaigned for improved screening, including access to a high quality NHS eye examination, issues of cost versus benefit come to the fore (7). Similarly as new and effective treatments/technologies become available that stop people losing their sight, we need to be able to compare the cost of treatment with the cost of blindness or partial sight. Specifically we need to know how much is being spent on benefits, services and tax allowances for people with sight problems by central and local government as well as the wider costs of informal care and lost productivity.


Methodology


Cost of illness studies measure the overall impact of a disease on society and typically they cover direct health and social care costs, the impact on employment and the provision of informal care by family and friends. A few studies have attempted to go further and estimate a monetary value for reductions in the quality of life caused by the disease using quality adjusted life years (QALYs) and disability adjusted life years (DALYs) (2).


The main focus of this study is people in the UK who are blind or partially sighted. There is a range of estimates. At a minimum there are around 370,000 people registered as either blind or partially sighted with their local authority. However it is generally accepted that this does not properly measure the number of people with very poor sight. First there is likely to be some degree of under-registration with people choosing not to enter “the system”. Second there are many people who have poor sight (i.e. below registration levels) but are treatable and therefore not eligible to register. RNIB, for example, estimates that there are 1.1million people in the UK whose sight is below registration levels. In addition this study is concerned with the costs of prevention, detection and treatment of eye disease. Here the focus is on International Classification of Diseases (ICD) categories 360-379.


The basic approach in cost of illness studies is fairly well established and estimates for a wide range of diseases have been published in recent years (8). In the case of blindness and visual impairment there have been both global studies (9) and country specific studies for Australia (10), Germany (11), and the USA (12). In addition there have been a number of studies that focus on specific issues related to visual impairment such as falls (13) and the associated costs. Finally there are studies that look at the costs related to specific eye diseases such as age related macular degeneration (AMD) (14).


This evaluation is prevalence based and estimates the annual cost of visual impairment for the UK in 2001/2. To achieve this, a wide range of data is brought together on prevention, detection, treatment and social support. Wherever possible we have used actual expenditure data from central and local government and the voluntary sector. However, where this is unavailable, we provide estimates based on relevant populations and unit costs. Employment related costs are quantified in terms of production losses.


A number of the estimates of the cost of visual impairment in the UK are based on data that is subject to uncertainty. To address this, a “sensitivity” analysis has been undertaken in which key aspects of the estimate in question are varied over a plausible range to assess the consequent change in the overall results.


Eye health costs


Health care is by far the largest area of Government expenditure on sight loss. A wide range of treatments and services are provided through the primary and secondary care systems to prevent, detect and treat eye disease.


As regards the detection and prevention of eye disease the General Ophthalmic Services provide free NHS eye tests and optical vouchers to help pay for glasses or contact lenses for eligible groups in the population. In the case of sight tests this includes people over the age of 60, children and students, adults receiving a range of low income benefits and people registered as blind or partially sighted or at risk of significant sight loss (15). The main eligible groups for optical vouchers are children under 16, students in full time education aged 16-18 and adults receiving Income Support, Family Credit or other low income benefits.


Table 1 Expenditure on general ophthalmic services: 2001/2

£ million

England

302.1

Scotland

31.9

Wales

21.9

Northern Ireland

10.3

Total

366.2


When a sight problem is detected during an NHS or private eye test, a referral will be made to either the patient’s General Practitioner or to the hospital eye service. In the case of hospital treatment, detailed cost and volume data for England is provided in the Department of Health National Schedule of Reference Costs. For ophthalmology this gives details for 12 categories of inpatient and day care cases and eight categories of outpatient services. A breakdown is also provided between NHS Trusts and Primary Care Trusts. For Scotland, Wales and Northern Ireland similar data is collected although utilising different categories. Table 2 sets out total expenditure on ophthalmology treatments across the UK making use of the published average cost and volume data.


Table 2 Expenditure on ophthalmology treatments: 2001/2

£ million

England


Inpatients

104.2

Day cases

199.2

Outpatients

263.7

Scotland

47.8

Wales

33.4

Northern Ireland

19.4

Total

667.7


This expenditure total covers treatment of patients with, for example, cataracts, glaucoma and AMD. What it does not include is NHS expenditure to meet other health needs related to sight problems. The most obvious example of this is falls caused by sight loss. As Scuffham et al have shown (13), this is a major problem in the UK.


In 1999 there were 189,000 falls involving people with a sight problem, of which 89,500 could be attributed to the sight problem. The estimated cost of these falls (primarily A&E attendances and inpatient admissions) were between £269million (range £193million-£360million) and £128million (range £32million-£240million).


GPs also play a significant role in the delivery of eye care in the UK, treating a range of minor sight problems and referring more serious cases on to Consultant Ophthalmologists. The most common reason for people to visit their GP is for disorders of the conjunctivia (ISD 372). For older people, glaucoma (ISD 365) and cataracts (ISD 366) are the next most important eye diseases that lead to a GP consultation. The fourth national study on Morbidity Statistics from General Practice (16) indicates the total number of consultations with a doctor for eye problems (ICD360-379) to be in the region of 490,000 per year. In 2001/2 the average cost of a consultation with a doctor in the surgery was £20 indicating a total cost of £98million.


Another area of significant expenditure is on drugs to treat eye disease. Here the data is available from prescription costs analysis and the British National Formulary. This indicates a total cost of some £92million in 2001/2. As new sight saving treatments that are in development become available we would expect this total to increase significantly.


A final area of expenditure within the health care sector is on low vision services. These are provided in a wide variety of settings, but most frequently by the hospital eye service or a community based optometrist practice. However as the National Eye Care Services Steering Group (NECSSG) recently concluded: “Currently services are fragmented and there is wide variation across the country in terms of both access and quality of provision” (1). This fragmentation makes it hard to estimate the current cost of low vision services. A figure of £8million is used here which includes the cost of rehabilitation workers (currently 600-800 across the UK) and the provision of low vision aids, but seeks to avoid double counting expenditure already included in the cost of the Hospital Eye Service. The NECSSG estimates that the cost of providing a comprehensive low vision service in England would be in the region of £40million suggesting a UK figure in the region of £45million.

Independent living costs

Social services


For people who have experienced significant sight loss, local authority Social Services Departments (Social Work Departments) may provide a number of services including registration, assessment, home care, rehabilitation, day care and community equipment. While this list appears impressive, in many parts of the country very little is provided in practice. Typically local authorities will register the individual and carry out an assessment but for over half of new referrals no services are provided.


In the case of England, detailed figures on those receiving community care from local authorities are available from the Referrals, Assessments and Packages of Care for Adults (RAP) project. This collects data from all 150 Councils with a social services responsibility.


Over the period 1 April 2001 to 31 March 2002, a total of 1,020,000 clients received a completed assessment of whom 33,000 (3.23 per cent) were visually impaired. Overall, 435,000 clients started to receive one or more new services following their assessment (42.6 per cent). In the case of visually impaired people, 15,000 started to receive a service (45.4 per cent).


In 2001/2 there were an estimated 1.63million clients receiving community based and residential services from their local authority. Of this total some 47,000 (2.88 per cent) were visually impaired. Community based services (home care, equipment, adaptations, professional support and day care) were provided to 1.37million people of whom 41,000 (2.99 per cent) were visually impaired.


In 2001/2 a total of around £11.1billion was spent on local authority personal social services in England (17) and if this was allocated pro rata to different client groups this would mean around £320million was spent on people with sight problems. Such a division is however implausible. There has been a marked shift of resources in recent years by social services departments towards people with high levels of need and a high level of perceived risk. People with sight problems are not seen to fall into this category.


An alternative source of data for expenditure by local authorities on blind and partially sighted people is the major survey of social services departments in England, Wales and Northern Ireland, carried out by the Tavistock Institute for RNIB. They found that “like estimates of number of clients, the question about the amount of funding available for services for visually impaired people caused many respondents difficulty” (18). Only a little over a quarter of Departments (27 per cent) were able to identify a discrete budget for the provision of services for people with sight problems. In other authorities, the budget for services for sight loss was part of a wider budget, either for sensory impaired clients (15.5 per cent) or for all disabled people (21.5 per cent).


Focusing on the 29 authorities where a budget for clients with sight problems could be identified, the average (including staff costs) expenditure was £222,269. Grossing this up to all “social care” departments in England, Wales and Northern Ireland gives a figure in the region of £44.5million.


Taking into account all of this data, a reasonable overall estimate of expenditure on social care for blind and partially sighted people would be in the region of £150million.


While expenditure on health and social services accounts for the majority of public spending on sight loss, a number of other services and benefits are provided by Government. These include social security payments, the blind person’s tax allowance, subsidised transport, television licence concession, etc.


Disability benefits


As has already been noted, a high proportion of blind and partially sighted people are over retirement age and will therefore be receiving a pension from the Government and/or their previous employer. Also, between one half and three quarters of blind and partially sighted people of working age are unemployed and dependent on social security payments (Incapacity Benefit and Income Support). However, it would be incorrect to include these payments in a cost of illness study since they are simply a transfer of purchasing power from one group in society to another. They do not represent any loss of output. To include Income Support and Incapacity benefit payments to people of working age with sight problems in a “cost of blindness” study, in addition to lost output, would be a form of double counting leading to a significant overstating of the true cost.


Disability Living Allowance (DLA) and Attendance Allowance (AA) should however be included. These are payments made to help disabled people meet the additional costs of their disability (19) and have been in place in some form since the early 1970s. DLA is received by around 60,000 visually impaired people and AA by a further 57,000. Total expenditure on DLA and AA in 2001/2 for people whose main disabling condition is “blindness” can be calculated using the number of people on the 11 different combinations of higher, middle and lower care and mobility rates (in the case of DLA) and the numbers on the higher and lower rates of benefit (in the case of AA). This gives a combined figure for expenditure on AA and DLA in 2001/2 of £254million.


The Blind Persons Tax Allowance is another way in which the Government seeks to assist with the additional costs of vision loss. This is available to those who are registered blind and is claimed by around 10,000 people. The total cost to the Treasury of this allowance in 2001/2 was estimated to be £10million.


Transport and mobility


Blind and partially sighted people face major barriers that frequently prevent them from travelling independently and safely. A report published by RNIB in 1999 identified these barriers and the various ways in which provision has been made to minimise their impact (20). The cost of these various interventions is difficult to estimate because provision can vary from one local authority area to the next. The most significant provisions relate to subsidised travel on public transport (buses, trains, trams and the underground) and the cost of taxicard schemes. Also, when calculating the cost, account must be taken of the fact that people over pension age become entitled to subsidised travel, irrespective of sight. For this group we need to measure the additional provision and cost associated with sight loss. In total it is estimated that provision to support the transport and mobility needs of people with sight loss amounted to £150million in 2001/2.


Education and training


There are around 22,000 children and young people in the UK aged 16 and under whose sight is impaired in such a way that they require additional support for their learning. Many of these children will be in mainstream schools and needing relatively little assistance. Others however will have another impairment and in some cases a multiplicity of disabilities which means they need intensive and expensive support. In addition there are an estimated 14,500 students with sight problems in colleges and universities who will also be requiring various degrees of support. In total a figure of £165million has been estimated as the additional cost of providing education and training for children and students with sight loss.


Employment services


Recognising the high level of unemployment amongst people with sight problems and other disabled people, the Department for Work and Pensions (DWP) provides a range of measures to assist with job placement and job retention. These include the Jobcentre Plus service, Access to Work, the New Deal for Disabled People, and Supported Employment. In general it is difficult to allocate expenditures under these programmes to different impairment groups. However it is known that people with sight problems are the second largest group using the Access to Work scheme (which helps to meet the in-work costs faced by disabled people). This has an annual budget in the region of £35million of which 30 per cent (£11million) is accounted for by blind and partially sighted users. RNIB’s second Adult Needs Survey (21) shows only three per cent of unemployed people with sight problems are actively seeking work, and therefore little of the remaining DWP disability employment budget can reasonably be included in this cost of illness study. Out of a total expenditure in the region of £115million, some £5million can be allocated to users with sight problems.


Costs to the voluntary sector


It was only in the twentieth century that the State started to make significant provision for blind and partially sighted people. Prior to that, services were delivered at local and national levels by charities, funded by individual donations. Despite the increased role for statutory provision, charities continue to deliver a wide range of services for people with sight problems. There are over 190 local societies for the blind across the UK providing services at local level including talking newspapers, day care, sheltered employment, eye clinic support, low vision aids, rehabilitation and transport.


At national level there are a number of major voluntary organisations including the Royal National Institute of the Blind, Guide Dogs for the Blind, Sense, Action for Blind People and the National Library for the Blind. These and other smaller national organisations also provide a wide range of services. In the case of RNIB this includes talking books, aids and equipment, schools and colleges, employment support, low vision services, eye clinic liaison officers, benefits advice and advocacy, disability rights advice and campaigning.


Income and expenditure data for 2001/2 was collected from all of the major national voluntary organisations and from a sample of local societies for the blind. This indicates total charitable expenditure in the region of £163million (having deducted expenditure/activity directly funded by Government e.g. the provision of rehabilitation services, a subsidy to a sheltered workshop, to avoid double counting).

Informal care


For many blind and partially sighted people, relatives and friends provide significant levels of informal care. Whilst this care is unpaid and not subject to market valuation, it is nevertheless important. It contributes to economic well-being just as much as paid care provided by either the local authority or a private agency. Indeed 10-15 years ago this care might well have been provided by the local authority. However, as has been noted, there has been a shift of resources towards groups that are deemed to be in greatest need and at greatest risk and away from those with chronic long-term conditions such as blind and partially sighted people.


Measuring the cost of informal care is difficult but not impossible. Carers UK have, for example, estimated the overall cost in the UK to be in the region of £57.4billion (22). The Office for National Statistics, using a different set of assumptions, came up with a figure of 13.9billion for informal care in the UK in 2000 (23). In their study of the costs of mental illness, the Sainsbury Centre, identifies a number of reasons for such a wide divergence between the two estimates and proposes a middle ground figure of £23.4billion (2).


Working with this global figure of £23.4billion and using data from the Department of Health’s survey of carers, supplemented by RNIB’s “Lost Vision” survey (24) and second Adult Needs Survey (25), we can estimate that the cost of informal care for blind and partially sighted people is £1.5billion. This is based on the conservative assumption of an average of one hour per day of care/support provided for those over the age of 60.


There has also been a shift of costs from the statutory to the private sector in the case of eye tests. In 1989 the Government restricted eligibility for the free NHS eye tests which had previously been available to the whole population. Now a third of all sight tests are paid for privately (4.9million tests in England in 2001/2). With an estimated average cost of a private test being £25, this represents a total cost in the region of £122.5million.


Costs to the private sector


Just as the Government can shift the costs of sight loss onto individuals and families, so also can it shift them onto the private sector. Here it uses legislation to require companies to deliver services to people with sight problems and to meet the cost themselves (rather than the cost being met by the Exchequer or by the individual).


The most important example of this is the Articles for the Blind scheme. This allows blind and partially sighted people and organisations “of” and “for” the blind to send braille and tapes through the post, free of charge. The scheme is needed given the weight of braille and tapes that would normally incur very heavy postal charges. Working from calculations made in the mid 1990s, we can estimate the cost of Articles for the Blind to be in the region of £35million.


Another example of costs being met by the private sector is audio description. As a consequence of provisions in the 1996 Broadcasting Act, television companies are required to audio describe a proportion of their programmes; 2 per cent in 2002 rising to 10 per cent by 2010. Audio description is an additional narrative channel that fits between dialogue and describes action, body language and facial expressions helping people with sight problems follow what is happening on the screen. The estimated annual cost in 2002 was in the region of £2million.


The cost of unemployment


It is usual in cost of illness/impairment studies to include an estimate of loss of productivity due to morbidity and mortality. In the case of sight loss there is a well documented negative relationship with economic activity. Overall, people with a serious sight problem are far less likely to be in paid employment than the general population. Also, those losing their sight at work are likely to have significant periods of sickness absence for treatment and rehabilitation.


One approach to estimating the productivity loss is to compare the employment rate of blind and partially sighted people of working age with that of the general population and to multiply the difference by average annual earnings.


In the 2001 Labour Force Survey, some 136,000 people of working age reported that they were disabled due to “difficulty seeing”; 84,000 men and 53,000 women (26). Of this total, 60,000 were in employment (44.3 per cent); 41,000 men (49.3 per cent) and 19,000 women (36.3 per cent). These employment rates are markedly lower than those for the non-disabled population (81.2 per cent overall, 86.6 per cent for men and 75.3 per cent for women). If the same rates applied some 112,650 people who have difficulty seeing would be in employment, indicating an “employment gap” of 52,650 (31,741 men and 20,909 women). Applying the relevant annual earnings figures for 2001 (27) indicates a productivity loss/cost of £1,082.7million.


Conclusion


The total cost of sight loss in the UK in 2001/2 was in the region of £4.9billion. As can be seen from table 3, around £2.3billion of this was the cost of health and social care, social security and a range of other services for blind and partially sighted people. A little over £1billion was the cost of productivity loss in the economy due to the low employment rate of people with sight problems. A further £1.5billion is the cost of informal care provided by relatives and friends.


Whilst most of the figures in this report are based on real expenditure data, in a number of cases it has been necessary to make estimates based on plausible assumptions about the population and the particular activity. In these cases it is important to undertake sensitivity analysis; that is to see how the figures we are using vary when we change our assumptions.


The most important area where sensitivity analysis is appropriate is that of informal independent living support provided by family and friends. The total figure of £1.5billion a year is based on an average of one hour a day independent living support being provided by friends and family to blind and partially sighted people over the age of 60. Varying these assumptions gives a range of £1.29billion to £1.72billion.


The other important area where different assumptions can be made is the cost of unemployment. It can be argued that there is no long term cost to the economy of blind and partially sighted people being out of work but merely short term transitional costs. We would argue that the costs to the individual and his/her family and friends are both real and high (28) and that £1.1billion is far from an over-statement of the economic exclusion that blind and partially sighted people face.


In the UK, successive Governments have failed to recognise blindness as a severe disability. As a result in far too many areas we have unsatisfactory and under-funded services. If the Government did provide quality services the annual cost of sight loss would be much greater. However targeted expenditure on four areas could help to reduce spending and save sight.


Table 3 Economic cost of visual impairment in the UK in 2001/2


Service

Total cost (£ millions)

General ophthalmic service

366

Ophthalmology treatments

668

GP consultations

98

Prescriptions/drugs

92

Low vision services

8

Local authority community care

150

DLA/AA

254

Blind persons tax allowance

10

Transport

150

Education and training

165

Employment services

16

Voluntary sector

163

Informal care by family and friends

1,500

Non-NHS eye tests

122

Private sector:


Articles for the Blind

35

Audio description

2

Productivity loss

1,083

Total cost

4,892


The four areas for targeted expenditure are:






References


1. Department of Health, First report of the National Eye Care Services Steering Group, 2004, London, Department of Health.


2. Sainsbury Centre for Mental Health, The economic and social costs of mental illness, 2003, Policy Paper 3, London.


3. McLaughlan, B., Early Detection and low vision rehabilitation: the key to dealing successfully with AMD, 2003, Toronto, AMD Alliance International.


4. Berthoud, R., Lakey, J,, McKay, S., The Economic Problems of Disabled People, 1993, London, PSI.


5. Dobson, B., Middleton, S., Paying to Care: The cost of childhood disability, 1998, York, York Publishing Services.


6. Baker, M., Thornton, T., Vernon, A., Winyard, S., The Costs of Blindness, 2000, London, RNIB.


7. Grindey, S., Winyard. S., Losing Sight of Blindness, 1997, London, RNIB.


8. Liu, J., Maniadakis, N., Gray, A., Rayner, M., “The economic burden of coronary heart disease in the UK”, Heart, 2002, 88: 597–603.


9. Frick, K., Foster, A., “The magnitude and cost of global blindness: an increasing problem that can be alleviated”, American Journal of Ophthalmology, 2003, April: 471–476.


10. Wright, S., Keefe, J., Thies, L., “Direct costs of blindness in Australia” Clinical and Experimental Ophthalmology 2000, 28: 140–142.


11. Pfau, N., Kupsch, S., Kern, A., Beske, F., Epidemiological and socioeconomic significance of blindness and severe visual impairment in Germany, 2000.


12. National Eye Institute, The cost of blindness in America, 1998, Washington, NEI.


13. Scuffham, P., Legood, R., Wilson, E., The cost of injurious falls associated with visual impairment in the UK, 2003, York, University of York.


14. Bonastre, J., Le Pen, C., Anderson, P., “The epidemiology, economics and quality of life burden of age related macular degeneration in France, Germany, Italy and the United Kingdom”, The European Journal of Health Economics, 2002, 3: 94–102.


15. Office for National Statistics, Ophthalmic Services for England 1991–92 to 2001–2, 2002, London, TSO.


16. Office for National Statistics, Morbidity Statistics from General Practice 1991–92, 1992, London, OPCS (ONS), Royal College of General Practitioners and Department of Health.


17. Department of Health, Annual Report, 2002, London, TSO.


18. Tavistock Institute, Survey of Social Services for RNIB (unpublished), 1999.


19. Social Security Advisory Committee, Social security provision for disability: a case for change, 1997, London, TSO.


20. Baker, M., Rights of Way, 1999, London, RNIB.


21. Bruce, I., Baker, M., Employment and unemployment amongst people with sight problems in the UK, 2003, London, RNIB.


22. Carers UK, Without us…? Calculating the value of carers support, 2000, London, Carers UK.


23. Office for National Statistics, Household Satellite Account, 2002, London, ONS.


24. Baker, M., Winyard, S., Lost Vision, 2000, London, RNIB.


25. Bruce, I., Baker, M., Second Adult Needs Survey, 2003, London, RNIB.


26. Smith, A., Twomey, B., “Labour market experiences of people with disabilities”, Labour Market Trends, 2002, August: 415–427.


27. Jenkins, J., “Patterns of pay: results of the 2001 New Earnings Survey”, Labour Market Trends, 2002, March: 129–139.


28. Baker, M., Simkiss, P., Beyond the Stereotypes, 2004, London, RNIB.

Other RNIB campaign reports


To order a copy, please contact RNIB Customer services on 0845 702 3153 (all calls charged at local rates) or email [email protected], quoting the appropriate PR number.


6 Lost vision: older visually impaired people in the UK

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8 Rights of way: transport and mobility for visually impaired people in the UK

ISBN 1 85878 186 8, 1998, £5.00

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12 The costs of blindness: examining the extra financial costs resulting from visual impairment

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14 Highly charged: how charging for home care affects blind and partially sighted people

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21 Travellers' Tales: making journeys safer for blind and partially sighted people

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© RNIB August 2004

Campaign report 23: The cost of sight loss in the UK

ISBN 1 85878 631 2

£5.00

Registered charity number 226227


ACTIVITIES FOR OLDER PEOPLE WITH SIGHT LOSS IN A
ADVOCACY OVERSIGHT OF LAW ENFORCEMENT REPORTS OFFICER CASE
AGGRAVATED ASSAULTUSE OF LASER SIGHTING SYSTEM OR DEVICE AGAINST


Tags: campaign report, 2004 campaign, campaign, sight