Sources of evidence

Self-assessment is the prime source of evidence but the claim pack should be checked to see who has completed it and that it is an accurate and reliable

description of their problems.

If the claim pack has been completed on behalf of the customer, by someone who has a good understanding of his or her needs, then it could provide good evidence.

• Hospital Factual Report
• The Cardiac Rehabilitation Nurse
• General Practitioners Factual Report
• HCP examination Report
• Medical Services

Hospital Factual Report

In all cases of moderate and severe cardiac disease a Consultant Cardiologist and a Specialist Cardiac Nurse would normally have been involved in the diagnosis, management and treatment of the individual. Indeed the absence of any documented history of a Cardiology consultation should raise doubts about the nature and/or severity of the given diagnosis. Hospital factual reports should therefore be obtained if required. If a person has undergone a successful heart transplant, the claimant will be followed up in the hospital Outpatient Department, and this will be the best source of information for his/ her residual needs.

The Cardiac Rehabilitation Nurse

The Cardiac Rehabilitation Nurse is a Specialist nurse, who works in close contact with the Cardiologist, and is part of the Cardiac Rehabilitation Team.

She/he is closely involved with the patient, from the start of the hospital stay, and, as well as attending to the physical needs of the patient, is crucial in advising and supporting the patient.

Heart failure patients suffer from an enormous impact on their confidence in their ability to do things and a large proportion of them suffer from depression and the Specialist Nurse is there to support them. She/he also can act as an intermediary between the Consultant (and the rest of the team) and the patient, giving advice on medication, dose adjustments, lifestyle, social issues and so on. He/she is also in a position to tell the patient about their illness and discuss things like prognosis, which may be worrying the patient, as well as being an important issue.

This contact is kept up after the patient is discharged, for both medical and psychological reasons; and phone contact, for reassurance of the patient, may take place several times a week, in cases of severe heart failure. At late - stage or end - stage disease, the patient may contact the nurse many times because of the need for psychological, financial or social support and for advice on managing often quite complex treatment regimes. Obviously, the amount of contact varies with the severity of the condition and the readiness of the patient to seek help.

The Specialist Nurse can also act as a go - between for the patient, GP and Consultant co-ordinating and adjusting the treatment options.

Therefore, this role is recognized as being extremely important for the well - being of the patients and more and more hospitals use their services on a permanent basis.

General Practitioner Factual report

The General Practitioner would normally have made the initial referral of the claimant to the Cardiologist and would normally be aware of the results of tests and current medication. The general practitioner may not have such detailed knowledge of the claimant’s needs if he/ she is more frequently managed by the Consultant Cardiologist and the Specialist Cardiac Nurse, (who are more likely to have detailed knowledge of exercise tolerance and the disabling effects of the condition).

If there is no specialist health professional involvement or evidence cannot be obtained from them, then a factual report from the claimant’s own doctor would be more appropriate.

HCP examination Report

An HCP examination report would be likely to be necessary when the person claims significant disability (equivalent to a moderate or severe condition), but there is no supporting evidence from the GP or hospital Specialist; if no corroborative evidence has been able to be obtained; or if it is the only means whereby the claimant’s needs can be clarified.

Medical Services

The Medical Services doctor may be asked to request relevant information such as test results from the GP or Hospital Consultant and to interpret test results and other information.

Amended April 2008