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Sight loss is more common among older than younger people. With an ageing population and increasing pressure on health and social care services, preventive and rehabilitation services are being prioritised. However, evidence around community-based vision rehabilitation services is underdeveloped. The focus of this article is on the prevalence, organisational models and capacity of community-based vision rehabilitation services in England that are wholly or partly funded by local authorities (LAs). Eighty-nine of the 152 (57%) LAs responded to an online survey about vision rehabilitation services. Services vary widely in: the type of provider, type of support offered, structure and skills of the team delivering interventions, caseloads and waiting times. Voluntary organisations appear to experience more pressure on budgets and staffing ratios than LA in-house services. The article discusses implications for practice.

Sight loss affects all aspects of well-being including daily functioning and mental health. Demographic trends suggest that the number of people with visual impairment is set to rise significantly, with many people experiencing an additional disability or health problems. By 2050, the number of blind and partially sighted people in the UK is estimated to increase by around 122 per cent, to approximately four million. Promoting preventive and rehabilitation interventions is recognised as a high priority for all care settings as a way of reducing demands on health and social care services. This research, funded by the Thomas Pocklington Trust, aimed to provide an overview of the evidence base for community-based vision rehabilitation services for people over the age of 18 with visual impairment. The study focused on rehabilitation services funded by local authorities to find out how these services are currently supporting people with visual impairment, what possible outcomes they might achieve and to identify gaps in the evidence base about current service arrangements. The study was carried out in England. Findings were intended to inform a future full scale evaluation as well as inform services.

Measuring the outcomes that are meaningful to people with long-term neurological conditions (LTNCs) using integrated health and social care services may help to assess the effectiveness of integration. Conventional outcomes tend not to be derived from service user experiences, nor are they able to demonstrate the impact of integrated working. This paper reports findings about outcomes identified as being important to people with LTNCs using integrated services. We undertook qualitative work with five community neuro-rehabilitation teams that were integrated in different ways and to different degrees. In-depth, semi-structured interviews were conducted with 35 people with LTNCs using these teams. Data were collected between 2010 and 2011 and analysed using an adapted version of the Framework approach. We identified 20 outcomes across three domains: personal comfort outcomes, social and economic participation outcomes, and autonomy outcomes. Inter-relationships between outcomes, both within and across domains, were evident. The outcomes, and the inter-relationships between them, have implications for how individuals are assessed in practice.

Background: Failure to demonstrate the effect of integration on service users using conventional outcome measures suggests that research to date has failed to measure the outcomes that actually matter to people with complex long-term conditions and that might result from integrated health and social care. Developing outcome measures that capture the important issues for service users may also help to better reflect the particular ways integrated teams work and what such teams strive to achieve in addressing service user outcomes. Objectives: The objectives of this research were to (1) identify factors that affect integration between health and social care, (2) identify outcomes important to people with long-term neurological conditions (LTNCs) who are clients of an 'integrated' service, (3) develop these outcomes into a checklist and explore whether or not these outcomes can be assessed in practice, and (4) understand how different models of integration affect outcomes. Design, methods and participants: A case study approach, using in-depth, semistructured interviews, was adopted. The cases were four English primary care trusts (PCTs) and their associated local authorities. Case sites had a neurological-rehabilitation team (NRT), each with a different approach to health and social care integration. The research took place in three stages. In stage 1, interviews with 43 commissioners, managers, NRT staff and social care practitioners, and documentary analysis, helped to understand service contexts and approaches to assessment. Interviews, guided by earlier outcomes work, were held with 35 people with LTNCs to identify important outcomes. Interviews with 13 carers illustrated relationships between NRTs and carers. In stage 2, these outcomes were developed into a checklist in partnership with NRTs. NRTs used the outcomes checklist (OC) as part of their routine assessment, and we monitored its use. In stage 3, we conducted interviews and focus groups with 21 NRT staff and 12 clients to evaluate the use of the OC in practice. Analysis: Qualitative data were managed and analysed thematically using the framework approach. Results: Person, service and structural-level factors influenced integration between health and social care. Relationships between practitioners and services often drove integration in practice. However, wider structural arrangements were important and could facilitate these relationships. We identified 20 outcomes important to people with LTNCs. These were grouped into three outcome domains: personal comfort, economic and social participation, and autonomy. Use of the OC in practice was viewed differently by the NRTs. One NRT felt that it duplicated existing assessments, one felt that it covered issues outside their remit and two felt that the OC worked for them. Some of the outcomes could be difficult for staff and clients to raise but clients felt that they should all be included in assessments. Use of the OC was sometimes challenging due to staffing and caseload pressures, changes to service structures and remit, and competing demands of other compulsory paperwork. All NRTs thought that the OC had potential value as a benchmarking or training tool. Larger, more interdisciplinary models of integrated NRTs appeared to give more scope for interpreting, assessing and potentially achieving outcomes. Conclusions: Many of the outcomes that are important to service users with LTNCs are not addressed in validated 'outcome measures'. This has implications for commissioners and practitioners to ensure that service users' needs are met in practice. Turning the OC into a measurement tool could go some way to addressing this. Many of the outcomes are interdependent, an impact on one particular outcome will have a 'knock-on' effect on other outcomes. These inter-relationships demonstrate the complexity of what is important in the lives of people with LTNCs. Service changes can affect integrated arrangements negatively. More research is needed to explore the longer-term effects of organisational change on integrated service provision.

There has been a growing interest in the topic of loneliness and social isolation over a number of years and a recognition that they have an impact on the health and wellbeing of individuals and communities. Local strategic organisations have an important role to play in tackling the problem of loneliness and social isolation in older people. The research aimed to identify the range of statutory and third sector organisations in North Yorkshire that could or should be able to identify older people at risk of loneliness and/or social isolation. Through these organisations, the sorts of activities that exist across North Yorkshire and some of their characteristics were described.

The report aims to provide a review of current literature that brings together knowledge about the extent and nature of loneliness among older people.This will help to clarify current thinking about what a "good practice" or service looks like and start to identify likely models of good practice in North Yorkshire.The report looks at how loneliness and social isolation are understood in the literature, why they should be important concerns of local strategic organisations, such as health and wellbeing boards, and what might be done. This evidence is set in the context of the geography and demography of North Yorkshire and suggestions for future work are made.

Objectives: To explore some of the key assumptions underpinning the continued development of general practitioner-led commissioning in health services. Methods: Qualitative data from two studies of service improvement in the English NHS were considered against England's plans for GP-led commissioning. These data were collected through in-depth interviews with a total of 187 professionals and 99 people affected by services in 10 different primary care trust areas across England between 2008 and 2009. Results: Internationally, GPs are seen to have a central position in health systems. In keeping with this, the English policy places emphasis on the 'pivotal role' of general practitioners, considered to be ideally placed to commission in the best interests of their patients. However, our evidence suggests that general practitioners do not always have a pivotal role for all patients. Moreover, it is planned that the new commissioning groups in England will not be subject to top-down performance management and this raises the question of how agreed quality standards will be met under the proposed new system. Conclusions: This paper questions the assumption that GPs are best placed to commission health services in a way that meets quality standards and leads to equitable outcomes. There is little evidence to suggest that GPs will succeed where others have failed and a risk that, without top-down performance management, service improvement will be patchy, leading to greater, not reduced, inequity.