Related to: Ageing Population, Socio-economic Inequality, Children and Young People, Education, Ethnicity, Ill Health and Disability, Mental Health and Illness, Older People, Alcohol, Anxiety and Depression, Diabetes, Employment and Economic Activity, Hypertension, Learning Disabilities, Special Educational Needs, Healthy Weight,Unintentional Injuries

Key Facts:

  • Estimates suggest that there are likely to be 19,000 adults with hearing loss in B&NES and this is predicted to increase by approximately 30% due to the Ageing Population.
  • It is estimated that there were 5,880 people living with sight loss in 2011in B&NES.
  • In 2012 it is estimated there were 63 blind and partially sighted children and young people aged 0-16 in B&NES.
  • It is estimated that in 2012 2,000 people were living with age-related macular degeneration in B&NES.
  • In England, the average spend on problems of vision was £40,900 per 1,000 head of the population in 2010-11.
  • Numbers of adults registered with services are much lower than estimates suggest would benefit from services
  • Adults and children with sensory impairments often have other physical or mental health conditions. 


The term 'sensory impairment' 1 is used here to refer to people with either visual or hearing impairments or both - the extent of those impairments will vary from person to person.

Visual impairments -2

Certificate of Vision Impairment (CVI) -The document signed by the ophthalmologist to identify someone as being 'sight impaired' or 'severely sight impaired'.

Sight impaired -The term used to identify someone who as been assessed by an ophthalmologist as being "substantially and permanently handicapped by defective vision caused by congenital (present at birth) defect, illness or injury."

Severely sight impaired -The term used to identify someone who as been assessed by an ophthalmologist as being "so blind as to be unable to perform any work for which eyesight is essential."

Age-related macular degeneration (AMD) -This condition commonly affects people over the age of 50 and is the leading cause of blindness in people over the age of 65.

There are two main types of AMD: neovascular or exudative AMD commonly known as wet AMD; and atrophic commonly known as dry AMD.

  • Wet AMD can develop quickly affecting central vision in a short period of time. Early identification and treatment of wet AMD is vital. Treatment can halt the further development of scarring but lost sight cannot be restored.
  • Dry AMD can develop slowly and take a long time to progress There is currently no treatment for dry AMD. People with early and moderate stages of DRY AMD are not eligible for registration, but it does have an impact upon a person daily life, for example they may have to stop driving.

Glaucoma -This is a group of eye conditions in which the optic nerve is damaged commonly, but not always, due to changes in eye pressure. Damage to sight can usually be minimised by early diagnosis in conjunction with careful regular observation and treatment.Many glaucoma patients will attend regular appointments and take eye drops for the rest of their lives to prevent deterioration of vision. Some forms of glaucoma can be treated with laser surgery and surgery.

Cataracts -This is a common eye condition that is prevalent in older people. The lens becomes less transparent and turns misty or cloudy. Cataracts over time can get worse and impact upon vision. A straightforward operation replaces the lens with an artificial one. A number of studies have demonstrated the cost benefits of cataracts surgery in improving life quality and reducing the number of falls.

Diabetic retinopathy - Diabetic retinopathy is a common complication of diabetes. It occurs when high blood sugar levels damage the cells at the back of the eye, known as the retina. If it is not treated, it can lead to blindness.3

Low vision -This refers to people who have some useful vision which can often be improved with low vision aids and adaptations. Low vision services may be based in a local hospital, located in opticians' practices or offered from a resource centre run by the local society for people with sight loss.

The causes of vision impairment in childhood are generally different to the causes of sight loss in adults. The four most common causes are:

Cerebral Vision Impairment is ante- or post-natal damage to the vision processing parts of the brain. (Cerebral vision impairment can be abbreviated to CVI)

Optic nerve disorders are a group of conditions where the optic nerve doesn’t transmit light signals to the brain correctly.

Retinal or macular dystrophies are umbrella terms for a range of inherited conditions which cause the retina to not function correctly.

Congenital cataracts can cause significant sight loss which is preventable if it is detected and quickly treated.

What does the data say?

It is believed that sensory impairment figures in B&NES are underestimated

Visual Impairments 4


There are 1.86 million people in the UK living with sight loss. By 2020 this number is predicted to increase by 22 % and will double to almost four million people by the year 2050.The increase can be attributed chiefly to an ageing population; over 80 per cent of sight loss occurs in people aged over 60 years. 5

It is thought that over 50 per cent of sight loss can be avoided. 6

Approximately 10% of UK blindness registrations are attributed to glaucoma and it's overall prevalence is around 2% of people over 40 7. This rate increases with age and is estimated to rise to almost 10% in people over 75. This is thought to be higher in people of Black African or Black Caribbean descent who have a family history of Glaucoma. Synthetic estimates based on incidence of serious visual impairments would place numbers locally at approximately 220 persons 8

Nationally 29% of those registered blind and 28% of those registered partially sighted were also recorded with an additional disability, (excluding those councils who supplied no figures for the additional disability section of the return)

Of those people registered as blind with an additional disability, 4% have a mental health problem, 8% have a learning disability, 60% have a physical disability and 27% have a hearing impairment

Of those people registered as partially sighted with an additional disability, 4% have a mental health problem, 4% have a learning disability, 61% have a physical disability and 30% have a hearing impairment 9

According to the Health and Social Care Information Centre at 31 March 2011 in England: 10

  • 147,800 people were on the register of blind people, a decrease of 5,200 (3 per cent) from March 2008. There were 9,100 new registrations to the register of blind people, a fall of 11 per cent compared to 2008.
  • 151,000 people were on the register of partially sighted people, a decrease of 5,300 (3 per cent) from March 2008. There were 11,800 new registrations to the register of partially sighted people, a fall of 10 per cent compared to 2008.
  • The percentage of people aged 75 and over in the partially sighted group was 66 per cent, compared to 64 per cent for the blind group. The overall age distribution of the partially sighted register is similar to that of the blind registrations.
  • The number of blind people on the register has decreased in all age groups compared to 31 March 2008 apart from the 50-64 age group which has risen slightly by 460 (3 per cent) from 2008.
  • The number of people registered as partially sighted has decreased in all age groups apart from those aged 18-49 which has increased by 575 (3 per cent) and those aged 50-64 which has increased by 430 (3 per cent).
  • 49,300 (33 per cent) of those registered blind and 50,400 (33 per cent) of those registered partially sighted were also recorded with an additional disability.
  • The most common additional disability was a physical disability, which accounted for 66 per cent and 68 per cent of blind and partially sighted registrations with additional disabilities respectively. The next most common additional disability was related to hearing which accounted for 22 per cent for both blind and partially sighted registrations.

At risk groups 11

Age - The prevalence of sight loss increases with age and the UK population is ageing.

Socio-economic Inequality - Evidence shows that there is a link between people on low incomes and living in deprivation and people living with sight loss; three out of four blind or partially sighted people are living in poverty or on its margins.

Employment and Economic Activity - 66% of registered blind and partially sighted people of working age are not in paid employment. People registered as blind or partially sighted are nearly five times more likely to have been not in paid employment for five years or more than the general population.

Ethnicity - The risk of developing glaucoma is higher in African and African-Caribbean populations. People from South-East Asia and China are at higher risk of angle-closure glaucoma. Evidence shows that people from the Asian population are at a higher risk of developing cataracts. African, African-Caribbean and Asian populations are at a higher risk of developing diabetic eye disease.

Learning Disabilities -There is a high prevalence rate of sight loss amongst adults with learning disabilities. An estimated 96,500 adults with learning disabilities in the UK, including 42,000 known to the statutory services, are blind or partially sighted. This means that nearly one in ten adults with learning disabilities is blind or partially sighted. Adults with learning disabilities are 10 times more likely to be blind or partially sighted than the general population.

Smoking -The link between smoking and Age-related macular degeneration (AMD), the UK's leading cause of blindness, is as strong as the link between smoking and lung cancer. Smokers not only double their risk of developing AMD but also tend to develop it earlier than non-smokers. Furthermore, smoking can make diabetes-related sight problems worse, and has been linked to the development of cataracts.

Obesity - Obesity has been linked to several eye conditions including cataracts and AMD.  Obesity also has a strong link to diabetes and an exacerbation of sight deterioration in diabetic retinopathy.

Stroke - Damage resulting from stroke can impact on the visual pathway of the eyes which can result in visual field loss, blurry vision, double vision and moving images.  Around 60 per cent of stroke survivors have some sort of visual dysfunction following stroke. The most common condition is homonymous hemianopia, a loss of half a person's visual field, which occurs in 30 per cent of all stroke survivors.

Blood pressure/Hypertension - In addition to increasing the risk of stroke, uncontrolled high blood pressure increases the risk of both retinal vein and retinal artery occlusion. Both conditions can cause sudden loss of vision in one eye and can lead to further complications.

Unintentional Injuries- A recent review of evidence on the link between falls and sight loss found that almost half (47 per cent) of all falls sustained by blind and partially sighted people were directly attributable to their sight loss.

Anxiety and Depression- Older people with sight loss are almost three times more likely to experience depression than people with good vision.

Bath and North East Somerset

PANSI synthetic estimates (2012) suggest that there approximately 4089 adults in B&NES (around 2.3% of the adult population) have a visual impairment (regional 2.5%, national 1.9%)

This is likely to increase from 4,089 in 2012 to 5,579 in 2030 12

2010 NHS figures indicate that 445 people are registered with B&NES council with Adult Social Services Responsibilities as blind, and another 475 people as partially sighted, this is equivalent to 0.51% of the population (mid-year estimates 2010 all ages) (0.57% regionally and nationally)

According to the Royal National Institute of Blind People it is estimated that in B&NES: 13

  • In 2011 there were 445 people registered blind. 
  • There were 475 people registered as partially sighted in 2011.
  • In 2010/11 there were 10 Certifications of Vision Impairment.
  • There were 5,880 people living with sight loss in 2011 this means that 3.3% of people were living with sight loss compared to overall population.
  • That 6,620 people will be living with sight loss in 2020 this would mean that 3.7% of people would be living with sight loss compared to overall population in 2020.

Total hospital admissions for problems of vision – Activity and costs have been higher than South West and national average since 2008/09 (though not in top 3).

Adults: visual impairments

Bath and North East Somerset

PANSI synthetic estimates (2012) suggest that there approximately 4089 adults in B&NES (around 2.3% of the adult population) have a visual impairment (regional 2.5%, national 1.9%)

This is likely to increase from 4,089 in 2012 to 5,579 in 2030 14

2010 NHS figures indicate that 445 people are registered with B&NES council with Adult Social Services Responsibilities as blind, and another 475 people as partially sighted, this is equivalent to 0.51% of the population (mid-year estimates 2010 all ages) (0.57% regionally and nationally)

According to the Royal National Institute of Blind People it is estimated that in B&NES: 15

  • That in 2012 2,000 people were living with age-related macular degeneration.
  • There were 1,360 people living with wet age-related macular degeneration in 2012.
  • That there were 640 people living with dry age-related macular degeneration in 2012.
  • That in 2012 there were 1,670 people living with cataract.
  • There were 1,530 people living with glaucoma in 2012.
  • In 2009 there were 3,490 people living with ocular hypertension
  • There were 3,100 people living with background diabetic retinopathy in 2009
  • That in 2009 there were 350 people living with non-proliferative and proliferative diabetic retinopathy

Adults: hearing impairments






% population


% population


% population















2011 Population figures







Table 2: Rates for moderate, severe or profound hearing loss for ages 18+ (PANSI synthetic estimates, 2012) 16

Table 2 indicates that B&NES has slightly higher than national rates of hearing loss, however rates are not higher than the regional percentage. It is predicted that moderate or severe hearing loss will increase by 30% in B&NES by 2030 and profound hearing loss by 39%. This is lower than the projected increase both regionally and nationally (regional percentage increase 43%/55% moderate and severe/profound, national percentage increase 42%/54% moderate and severe/profound)


Figure 1: PANSI synthetic estimates of moderate or severe hearing loss by age and gender (2012)

Figure 1 indicates that a percentage of men have hearing loss at an earlier age than women, however by the age of 85+ hearing loss is the same between menand women17

It is predicted that hearing loss will increase by around 30% by 2030 in B&NES (44% regionally, 43% nationally) due to the [[aging population]].

Hearing loss significant increases with age (19% of 65-74 year olds have moderate or severe hearing loss increases to 85% of the 85+ population)

Synthetic estimates predict that Moderate/ severe hearing impairment will increase from 18,579 in 2012 to 24,114 in 2030

Synthetic estimates predict that profound hearing impediment – 426 in 2012 to 592 in 203018

There are 55 people registered as hard of hearing with B&NES council with Adult Social Services Responsibilities (31st March 2010) this is 0.03% of the population compared with 0.28% regionally and 0.41% nationally19

Total admissions for problems of hearing – Activity and costs generally below the South West and national averages20

A report called Hearing Matters; Action on Hearing Loss (2011) found:21

Hearing loss has significant personal and social costs and can lead to high levels of social isolation and consequent mental ill health. It more than doubles the risk of depression in older people and children with hearing loss also have an increased

Hearing loss has a significant impact on education and employment. In 2009 in England, 71% of deaf children failed to achieve the government benchmark of five GCSEs at grades A* to C, including English and Maths.

Hearing loss affects one in six of the population

In 2010, the UK spent £1.34 on research into hearing loss for every person affected. This compares to £14.21 for sight loss, £21.31 for diabetes, and £49.71 for cardiovascular research.

45% of people who report hearing problems to their GP but are not referred for a hearing test or hearing aids.

Only one in three people who could benefit from hearing aids has them.

Age-related damage to the cochlea, or presbycusis, is the single biggest cause of hearing loss. This process occurs naturally as part of the ageing process.

Other causes and triggers of hearing loss include:

  •           regular and prolonged exposure to loud sounds
  •           ototoxic drugs that harm the cochlea and/or hearing nerve
  •           some infectious diseases, including rubella
  •           complications at birth
  •           injury to the head
  •           benign tumours on the auditory nerve
  • genetic predisposition: at least half of all childhood deafness is inherited; so far scientists have found 80 genes related to deafness.

Prevalence increases with age; the Medical Research Council estimate prevalence will increase by around 14% every 10 years.

People with mild hearing loss have nearly twice the chance of developing dementia compared to people with normal hearing. The risk increases threefold for those with moderate and fivefold for severe hearing loss.

Research conducted in 2007 into the employment experiences of severely and profoundly deaf people, found that at a time of near full employment, deaf people were four times more likely to be unemployed than the general population, with negative attitudes from employers seen as the main barrier to getting a job.

Estimates published in 2006 suggest that £13bn is lost to the UK economy every year through unemployment linked to hearing loss.


0.57% of the UK population is thought to be deafblind

Sense estimate 1077 deafblind people in B&NES in 2010 increase to 1,704 deafblind people in B&NES in 2030 22

The number of deafblind people in the UK is expected to rise dramatically as the proportion of the population aged over 85 years is projected to trebleby 2050 23

49 people registered as deafblind with B&NES (Sirona). There are many others that social services deal with who this team aren’t aware of and so are never registered. As well as that there are other people in the community who services are totally unaware of 24 

Children and young people

 B&NESSouth WestEnglandB&NESSouth WestEngland
Hearing impairment3.10%2.30%2.10%1.90%2.30%2.40%
Visual impairment1.00%1.20%1.30%2.30%1.40%1.30%
Multi-sensory impairmentx0.20%0.20%0.00%0.10%0.10%

Table 1: Children with special educational needs or at school action plus (as at Jan 2009) with sensory impairment 25

Table 1 indicates that there are 1% more children with Special Educational Needs (SEN)/ School Action Plus in secondary school due to visual impairment in B&NES compared with nationally. There are also 1% more children in primary school with SEN/ School Action Plus with hearing impairment in B&NES compared with nationally, however this is not seen at secondary stage26

Children and young people: visual impairments 27

Vision impairment in children is a low incidence high impact disability. Children with vision impairment have different needs to adults with sight loss. In order to reduce lifelong inequalities, it is important that support is provided from birth, throughout childhood and the transition into adulthood. If this support is not received, then during their development, and life, chances can be severely limited.

Significant vision impairment can delay early childhood development and learning; including social communication, mobility, and everyday living skills. Children with vision impairment are at risk of poor outcomes across a range of emotional and social wellbeing indicators, which can have an effect on adult life, limiting work opportunities. It can also have a major impact on the wellbeing and coping capacities of the family.

Children most at risk of vision impairment 28

Premature and low birth weight babies - are at risk of underdevelopment of ocular structures, increased risk of squint, and cerebral vision impairment. Very premature and low birth weight babies are at particular risk of retinopathy of prematurity, a preventable condition. Ocular screening on premature babies is recommended.

Genetic eye conditions can affect any structure of the eye or visual pathway. They are prevalent in socioeconomically deprived groups and in ethnic minority populations, particularly South Asian.

Maternal infections such as measles and rubella can cause childhood vision impairment. Measles immunisation is necessary to reduce preventable childhood blindness.

Alcohol and drug exposure -a high percentage of children suffering from foetal alcohol syndrome have vision impairment and develop eye abnormalities. Maternal drug misuse affects the development of the eye and visual system causing sight loss.

Smoking - exposure to maternal smoking increases the risk of prematurity, low birth weight and of ocular complications.


Children with learning disabilities have a very high prevalence of vision impairment. The estimated prevalence rate for vision impairment in the learning disabilities population aged 0-19 in the UK is 5.6%.


National 29


The number of children with vision impairment is increasing, which is demonstrated by a steady year on year increase of children registered as blind or partially sighted. 

An estimated 2 in every 1,000 children and young people up to the age of 18 in the UK meet the WHO criteria for blindness and vision impairment.

An estimated 5 in every 10,000 of these children up to the age of 16 are severely sight impaired.

Cerebral vision impairment accounts for 48% of blindness in children and between 32% and 45% of all children with vision impairment.

Optic nerve disorders account for about 28% of severe vision impairment in children.

It is estimated 200-300 children are born with congenital cataract each year in the UK.

Bath and North East Somerset

According to the Royal National Institute of Blind People it is estimated that in B&NES: 30

  • That in 2012 there were 63 blind and partially sighted children and young people aged 0-16.
  • That there were 55 blind and partially sighted children and young people aged 17-25 in 2012.

Children and young people: hearing impairments

There are approximately 155 children with either permanent or acquired hearing loss or impairment known to teachers of the deaf and receiving visits for support31

Data on severity of hearing loss is not currently available for B&NES. However figures can be apportioned to B&NES (CCG) from across the service, which also covers parts of Wiltshire and Somerset, to identify that there are probably the following levels of need in B&NES:










Approximately 20 of these children have additional health needs.

Sensory support service for children

Locally the Sensory Support Service currently provide support for children with hearing and vision needs from early years and through their time at school. Their Service Report 2009 lists 129 supported with hearing loss, with hearing loss for 22 of them listed as “severe” or “profound”. The figure for visual impairment is 41, with 13 being “severe” or “total”. The figure for multi-sensory impairment was 8.32

The Sensory Support Service report indicates that sensory impairment is not necessarily linked to social and economical issues - there is very low incidence of disability/SEN and can happen to anyone whatever their social economical context 33

Sensory Support Service caseload – 185 children (51 visually impaired, 121 hearing impaired, 13 with multi-sensory impairment. Levels of need range from a mild impairment with an emphasis on providing support and building the capacity of schools to meet the child’s needs and carry out regular assessment to profound, e.g. educationally blind children and profoundly deaf children. Some of the children supported by the service have additional needs including those with profound and multiple learning difficulties.

Visual Impairment total 51, 19 have additional SEN (Special Educatinal Needs)

Hearing Impairment total 121, 28 have additional SEN needs

Multi Sensory Impairment - total 13, 6 have additional SEN needs34

NDCS (National deaf children society) says that about 40% of deaf children develop mental health issues. Visual Impairment and obesity is often mentioned as a potential issue 35The Sensory Support Service work to prevent this.

Up to half of children who are blind from birth have other disabilities that can limit their potential (see sensory impairment and mental health section below).

Sensory impairment and Mental Health and Illness 36

Early onset of significant visual or hearing impairment can have a profound effect on a child’s development, with adverse consequences for mental health, both in childhood and adult life.

Hearing aids are often inefficient and even painful to use, and many NHS aids are left unworn. The introduction of digital hearing aids and the wider availability of hearing therapy should improve this situation

Deaf children have an increased prevalence of mental health problems

Reasons for this include:

  • An excess of organic problems (usually due to the cause of the deafness)
  • An excess of emotional, psychological and behavioural disorders
  • Delays in access to service, which increase the duration of mental health problems
  • Mental health care for deaf people is often poor

There can be many difficulties and delays before deaf adults are seen by appropriate mental health services. However, the nature and level of mental health problems are similar to those in the general population.

Economic cost of visual impairments 37

The associated costs and demands on NHS outpatient services are high with ophthalmology having the third highest attendances in 2011-2012.

In 2008 the direct and indirect costs of sight loss was £6.5 billion and by 2013 these costs was predicted to rise to £7.9 billion.

In England, the average spend on problems of vision was £40,900 per 1,000 head of the population in 2010-11; a total cost of £2.14 billion that year.

The main direct healthcare costs associated with eye care include:

Primary care

  • Ophthalmic - primary ophthalmic services
  • Prescribing and pharmacy - primary care prescribing relating to ophthalmology. 

Secondary care

  • Inpatient elective and day cases - all admitted patient care ophthalmology activity which takes place in a hospital setting where the admission is either elective or a day case

Outpatient - expenditure relating to ophthalmology outpatient attendance or procedures

What does the community say?

Over 90% ratings of good or better for the quality of service provided according to families and schools or early years settings - evaluation questionnaires. National and formal quality assurance processes for the newborn hearing screening have consistently rated the service as a well above average with a culture of continuous improvement

National and formal quality assurance processes for the newborn hearing screening have consistently rated B&NES Sensory Support Service as a well above average service with a culture of continuous improvement38

Children and young people feel that it is important for everybody to learn to sign in order to improve communication between adults and young people

There was a concern that people with disabilities should receive mainstream recognition and that effort should be made by the majority towards supporting the minority, that signing should be part of everyone’s set of communication skills39

Action on Hearing Loss 2008 members’ survey showed that 79% of people, when fitted with hearing aids, did not receive any information about other services or potentially useful technology. In their 2010 Annual Survey, the majority of respondents who have attended a class said lip-reading improved their communication skills (63%) and helped them deal with hearing loss (60%)

A survey about access to healthcare found that over a third (35%) of people with hearing loss have experienced difficulty communicating with a GP or nurse

The same amount have been left unclear about their condition because of communication problems with their GP or nurse

Over a quarter (28%) find it difficult to contact their GP surgery to get an appointment because of their hearing loss

Almost a quarter (24%) have missed an appointment because of poor communication, including not being able to hear staff calling out their name40

Are we meeting the needs?

Hospital admissions for problems with vision are higher (for activity and costs higher) than South West and National, whilst admissions for problems with hearing are lower 41

There is one educational audiologist in training - succession planning is an issue, more social care input is needed42

Prevention and early diagnosis can significantly reduce the impacts of hearing loss

In addition to hearing aids and/or surgical interventions, people with hearing loss might require sensory services such as lip-reading classes and access to assistive technologies to help maximise independence and wellbeing. However, referral to these services is inconsistent and many people are not referred at all

Personal Independence Payment (PIP) from 2013 may have tougher eligibility criteria, and that some of the 40,000 people with hearing loss who currently claim DLA will lose an important source of income

Access to the law continues to be inconsistent for people with hearing loss. Many courts do not have working loop or infrared systems, and there are issues around access to legal advice. There is a need to raise awareness about the role of sign language interpreters and other communication professionals in the legal sector, as well as in the prison service, where the communication needs of deaf prisoners are often not taken into account 43

According to the Royal National Institute of Blind People, in B&NES: 44

  • There are 2 NHS hospitals with eye clinics.
  • There is 1 hospital location with an Eye Clinic Liaison Officers or early reach support.

What can we realistically change?

The low incidence nature of sensory impairment means that it cannot be provided for everywhere. What the community can do is ensure that facilities are as inclusive as possible and that staff employed understand the issues, so for example training in Deaf and Vision Awareness could be useful for example in shops, leisure facilities, etc so that CYP can access services.

The community could also support with transport so that families can travel to access services, e.g. family sessions for visually impaired or deaf children - parents say how crucial these are, they share information with other parents in similar situations which they cannot find locally, they access information from specialist teachers and others who provide information on sensory impairment, etc 45

Children with visual impairments  46

Vision 2020 UK Children and Young People’s group have developed guidelines and a pathway; which sets out the key needs and support milestones for children and young people and their families from the moment vision impairment is identified through to transition into the adult pathway. These guidelines are intended for those responsible for commissioning and providing services for children and young people and their families. 

They will assist with the interpretation and implementation of the UK Vision Strategy across health, education and social care.

The guidelines and pathway can be found: