Joint working across education, health and social
care effective practice case study: Bedford
Borough vision impairment (VI) Team
Bedford Borough VI Team
Background
The Bedford VI Team (education) is part of the Sensory and Communication
Support Team. This team is an education team and comprises vision
impairment (VI), hearing impairment (HI) and autistic spectrum conditions
(ASC) advisory teams employed by and working across Bedford Borough,
which is a unitary authority.
Prior to 2009 there was a single local authority – Bedfordshire County Council.
Since then, all services have been split between Bedford Borough Council and
Central Bedfordshire Council. Because many of the current employees had
been used to working together, this meant that staff have remained in touch
and continued to work collaboratively.
There are approximately 90 children and young people from 0-19 on the
Bedford Borough VI caseload, supported by two qualified teachers of children
and young people with vision impairment (QTVIs), one of whom is also the
manager of the VI team. The team also has four centrally employed specialist
teaching assistants and a resources officer / technician. The VI team is based
at the Child Development Centre (CDC) in Kempston. The CDC is run jointly
by Bedford Borough Council and Health Services. This enables very close
liaison with colleagues from health.
Partner agencies
Health partners
There are several health partners, including those from across several
geographical and service boundaries:
 ‘Moorfields at Bedford’ which runs the Paediatric Ophthalmology eye
clinic, based at the Enhanced Service Centre (known locally as the Bedford
Hospital North Wing) and provides the consultant paediatric
ophthalmologist. There are ophthalmologists working in other
ophthalmology specialisms on the other Bedford Hospital site, South Wing,
who will also refer to the VI service.
 Bedford Hospital NHS Trust has a range of health professionals
employed by the Trust. These include consultant paediatricians, ,
– supporting people with sight loss
charity numbers 226227, SC039316 and 1109
audiologists, physiotherapists, occupational therapists, and speech and
language therapists
 South Essex Partnership University NHS Foundation Trust (SEPT)
provides the Community Eye Service, which comprises orthoptists,
community ophthalmologists and optometrists who are based in various
locations across Bedfordshire. SEPT has different boundaries to Bedford
Hospital NHS Trust. In Bedford, the main base is the Enhanced Service
Centre and there is also a peripheral clinic in Flitwick, Biggleswade and
Shefford (Central Bedfordshire). The orthoptists also provide services for
children with multiple disabilities at the Child Development Centre in
Bedford, the Edwin Lobo Centre in Luton and also to 5 special schools
across Bedford Borough and Central Bedfordshire.
Social Services partners
The Social Services Sensory Team is a specialist team for children and adults,
covering all ages including babies. The team works across the whole of
Bedfordshire (with the exception of Luton) and is a shared service hosted by
Bedford Borough Council. In addition to providing social care and rehabilitation
services, the Social Services team maintains the CVI (Certificate of Visual
Impairment) register of people in the county who are severely sight impaired or
sight impaired.
There are five members of staff in the team comprising:
 One Advanced Practitioner (Social/Rehabilitation Worker)
 One Social Worker
 Four Rehabilitation Workers
 Three Community Support Workers
 One Administrator
 One Support Administrator
All mobility and some everyday living skills training for children and young
people in Bedford are provided by this team. One of the four Rehabilitation
Workers, who has a number of years of experience, leads on the work with
children and young people and works most closely with the VI Education
Team. All the Rehabilitation Workers also have school age children on their
caseload.
The criterion for support from the Social Services Sensory Team is that the
child has a significant (not correctable) VI that will impact on their
independence. The child or young person does not have to be registered to
have an assessment and support.
rnib.org.uk
The Children with Disabilities Team is based in the same office as the VI
Social Services team and the two services work closely together. The VI
Social Services team advises parents that, in addition to a habilitation
assessment, their child can also be assessed by the children with disabilities
team.
Current working relationship with partner agencies
Referrals between agencies
There are formal procedures, including the certification and registration
process, to refer children and young people. As everyone works closely
together, each team tries to ensure that parents and children are seen as soon
as possible following identification of a VI.
 Health to education: the referral system from health to the education VI
team is made complicated by the large number of referral routes and which
of the allied health or medical professionals makes the referral.
Ophthalmologists usually refer by letter to the VI team – the letter will
include a signed consent to the referral from the child’s parent/carer. Many
referrals are from local Orthoptists who use the referral form.
 Health to social services: the main referral route is usually through the
CVI process, and all the hospitals know the procedure. While there can be
delays due to different administration processes in the various consultants’
clinics and clinic venues, and staff shortages at the hospital, good links and
systems between the hospitals and Social Services are in place. Referrals
can also be made for any child with a significant VI who is not
certified/eligible for certification but may require mobility and rehabilitation
training.
 Education to social services: this is a formal process, using a designated
referral form for mobility input, for when the education VI team is aware of a
child who isn’t registered but will require support from a Rehabilitation
Worker. Due to the good working relationship between the teams, these
referrals are usually picked up quickly.
 Social services to education: if the social services team receives a CVI
for registration, they will check that the VI education team has also received
a referral for that child.
 Schools to VI (education): There is an established referral form, which
should be completed by the head teacher / SENDCo.
rnib.org.uk
Education and Social Services joint working
The Social Services VI Team provides mobility and age appropriate
independence training for children and young people. There is some crossover
with education as the VI team may already be supporting a pupil in practical
lessons at school (e.g. food technology), whilst the Rehabilitation Worker
teaches some everyday living skills as appropriate and also encourages
families to promote/encourage the child’s independence.
Following registration of a baby or child, the Social Services Rehabilitation
Worker, who leads on work with children, will make a joint home visit with the
Qualified Teacher for the Visual Impaired (QTVI) so that they can both explain
their different roles and the ways in which each team will be able to support
the child or young person (CYP) and their family. This is more helpful for
parents than having different professionals visiting independently of each
other.
As the same team provides mobility and rehabilitation throughout childhood
and into adulthood there is no formal transition from Children’s to Adult
Services; mobility training continues to be offered and provided as and when it
is needed. The Rehabilitation Worker becomes involved in transition planning
for young people moving from school to further education.
For young people planning to go to university in a different local authority area,
the Bedford Social Services Team can ensure that a referral is made to the
relevant person/team in the host authority. They can also keep track of how
support is progressing. When young people return to the Local Authority from
out of authority settings they know that they can contact the team for further
support if it is needed.
Education and health joint working
Joint working with the QTVI and orthoptists is arranged where both parties feel
this would be beneficial. This includes working together in Developmental
Vision Clinics and joint assessments in schools.
The VI Team also carries out joint working with other health professionals, for
example, occupational therapists and physiotherapists. This includes
assessments at the CDC, joint visits to home and educational settings and
combined written reports.
The VI Team has had links with the low vision clinic when team members
attended low vision assessments with individual children and their parents
/carers if invited. Due to changes in LV personnel however, this link is
sometimes difficult to sustain.
rnib.org.uk
Multi-agency meetings
All professionals involved in providing services to CYP with VI in Bedford
Borough and Central Bedfordshire meet 2-3 times a year. Attendees include:
peripatetic VI teachers, consultant ophthalmologists, paediatric optometrists,
orthoptists and Social Services VI Team staff. The meetings enable group
members to share information in person in addition to emails and phone calls.
These meetings typically include:
 opportunities to discuss pertinent issues such as new government or local
policies/procedures/guidelines
 individual members sharing their expertise in a particular area
 supporting professional development of the other members of the group
 case discussions of individual children.
Topics discussed in a single meeting in 2016 included CQC inspections, a
NICE consultation on transitions, EHCPs for children with VI and ways to
overcome challenges related to the assessment process, a presentation on
various childhood eye conditions, and advice about ways to support an
individual child.
The group has jointly produced an information booklet for parents:
http://www.moorfields.nhs.uk/sites/default/files/uploads/documents/Bedford%2
0Children%20Booklet.pdf
What factors make the partnership working effective and
enables it to be maintained?
 Historical factors: an embedded way of working together which has
survived subsequent boundary and other changes. Meetings between the
VI team, orthoptists and social service VI teams had already been
established and when new paediatric consultant ophthalmologists came
into the area, they built upon this existing arrangement.
 Personnel factors (individual and group): the paediatric consultant
ophthalmologist (the current post holder and her predecessor) played a key
part by bringing in other clinicians working with vision impaired children, in
particular paediatric ophthalmologists and associate specialists who
weren’t previously involved with the group. A key factor in effective
partnership working is the personal integrity and dedication of the
professionals involved. They all recognise that interlinking has been an
ethos of all teams over many years. There have been few staff changes.
Recognising this ethos and the benefits of joint working, the paediatric
ophthalmologists have supported and enhanced its development.
rnib.org.uk
 Mutual respect: all the individuals involved have a good relationship with
each other and respect for each other’s professional role.
 Leadership/ having a key contact from each sector/group: These are
the consultant paediatric ophthalmologist, the manager of the Bedford VI
team, the team leader of the social services VI team, and the team leaders
of the SEPT (orthoptists) team.
 Forward thinking and planning: also links to the previous and subsequent
points – the meetings are booked around the eye clinics so a great deal of
forward thinking and planning is needed. The meetings alternate between
Bedford and Luton, to ensure that the time spent travelling to the venues is
split equally for all.
 Sharing of responsibility: reminding each other that a meeting is due,
making sure the meeting is taking place, sharing the organisational
arrangements, making suggestions for the meeting content and offers to
present a topic.
 Location factors: having so many staff from different disciplines based
together in the CDC where relationships can be maintained via informal,
face to face contact – this is most useful for the Bedford VI team
 Bringing these all together: the main reason for the current meetings
between the VI teachers, social services staff and orthoptists is to foster the
continuation of an established arrangement; individuals are motivated to
maintain the system and the professional relationships between these
individuals.
What are the challenges to partnership working?
Many of the challenges detailed below have put strains on partnership working
as individuals come under increasing pressure and become more
demoralised. Yet the continuation of this partnership approach becomes ever
more important – not just for reasons of morale but also to ensure continuation
during a period of constant change. This is something that is understood by
managers, who have continued to be supportive.
 Pressures on individual services due to the external context: in the
past few years the teams have been working under increasing pressures
due to a combination of budget cuts and rising caseloads of children
including an increase in the number of those with more complex needs.
Competing demands on staff members’ time as a result of these pressures
rnib.org.uk
means that there is less time for joint meetings and other aspects of
partnership working. Extra effort is needed to ensure that the partnership is
maintained.
 Organisational changes: organisational changes that have occurred as a
direct response to local authority budget cuts, and changes to NHS
organisation at local level, can present a challenge to partnership working,
particularly where this leads to changes in systems/structures or to
personnel.
 LA and health boundary differences and the high number of health
sites: one of the aims of partnership working is to ensure prompt referral
and good communication between health, education and social care. This
is made more difficult by the large number of different health sites and
providers in the local area. Devising a referral system from health to
education that can deal with the number of health sites and providers is
proving to be an ongoing challenge which the partner agencies are
continuing to work on.
Impact on EHCPs
While the EHCP process is led by a separate, central SEND team in Bedford
Borough, for children with VI, the multi-disciplinary working relationship makes
the process of working on EHC assessments and plans more straightforward.
All relevant professionals meet together with the child or young person’s
parents (and the child/young person where relevant) to discuss the EHCP and
to go through the draft plan in detail. Following discussion, a final draft of the
EHCP is issued and then reviewed.
Benefits for parents and children and young people
A holistic approach to support enables a rounded picture of the child or young
person to be obtained. Whether support is led by health, education or social
services depends on the identified needs of the child/young person. The lead
team may change as needs change.
The informal, as well as formal, relationship between professionals means that
children and young people are usually seen promptly and things get followed
up.
The relationship between the different sectors means that a child is less likely
to drop out of the system/part of the system because a professional in one
team can follow up with a professional in another team. For example, if the
QTVI is talking to the parent at the school or at a review meeting and finds that
rnib.org.uk
the child hasn’t had an eye clinic check-up for some time then, with the
parent’s permission, the QTVI can follow up with the health team to make sure
they are still in the system and re-refer if required.
Additional information
Other partnerships: The Bedfordshire Eye Care Working Group (BECWG)
BECWG was developed out of the Vision2020 UK initiatives. Launched 3-4
years ago, it brings together health, social care and the voluntary sector to
support a collaborative steering group across eye care and eye health
organisations in influencing and informing on local eye health, eye care and
sight loss needs and requirements for the people of Bedfordshire. The
purpose of the group is to review current strategies and identify areas for
inclusion or enhancement to eye health, eye care and sight loss in the local
communities.
The manager of the VI team, the orthoptic team leader and the social services
team advanced practitioner felt that there should be something for children
and young people as well as for adults. As a result, BECWG is now also
focusing on prevention – getting children and young people to be more aware
of eye health. The main push over the last few years has been to engage and
encourage children to have regular eye tests from an early age. The group is
now looking at working with health visitors and midwives.
So far, BECWG initiatives involving children and young people have been:
 December 2013: exploring different avenues regarding eye health and
preventative sight loss and considering how to promote the importance of
eye health to children in Bedford Borough
 February - March 2014: real time display boards were used at locations
across the borough, to advertise the importance of children having their
eyes tested.
 September 2014: a competition was held at all schools in Bedford Borough
to raise awareness of National Eye Health Week. Pupils were asked to
design a poster entitled “Healthy eyes are important because ….”
 September 2015: for National Eye Health Week, BEWCG ran a series of
workshops in Bedford Borough schools, in partnership with Moorfield’s
Hospital and the ‘Eye Heroes’ pilot project . The aim was to empower
children in their formative years, via interactive workshops, to become ‘Eye
rnib.org.uk
Heroes’ and inform adults and children in their communities about eye
health and the benefits of eye tests.
 Summer 2016: as the date for National Eye Health Week in early
September is difficult for schools and staff, the VI and social services teams
created posters about eye health, aimed at families to encourage eye tests
for children. Different agencies involved in BECWG then worked together,
using the posters, leaflets and interactive activities, at Bedford’s biennial
summer River Festival to promote the importance of eye care for both
children and adults.
rnib.org.uk