Sources of evidence

Note: If considering entitlement to H/R Mobility component under the Severely Visually Impaired (SVI) provisions, the following evidence source must be used:

The Consultant Ophthalmologist will be able to provide information about symptoms, signs, investigations including assessment of vision, treatment/management, and is likely to have information about resulting disability or needs.

Other evidence sources

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.

Sources of Further Evidence in Diabetes are:

• The Specialist Diabetic Nurse
• Hospital Factual Report
• General Practitioner Factual Report
• HCP examination Report
• Medical Services

The Specialist Diabetic Nurse

The Specialist Diabetic Nurse is a Specialist nurse, who works in close contact with the Consultant Diabetologist, and is part of the Diabetic Team.

He/she is closely involved with the patient, from the start of attendance at the hospital clinic, and, as well as attending to the physical needs of the patient, is crucial in advising, and supporting the patient. The Diabetic Specialist Nurse may have more contact with the patient, than the Consultant, through informal contact and phone calls, (especially in the cases of teenagers and young adults, who do not wish to have too much contact with the hospital).

Some diabetic patients suffer from depression, and the Specialist Nurse is there to support them, and refer onwards, to a Psychologist or Psychiatrist, if necessary. She 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 frequently. 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 recognised as being extremely important for the well - being of the patients and more and more hospitals use their services on a permanent basis.

Hospital Factual Report

In all cases of moderate and severe diabetic disease a Consultant Diabetologist, and a Specialist Diabetic Nurse would normally have been involved in the diagnosis, management and treatment of the individual. In the presence of established complications, there will be involvement with a Consultant Cardiologist, Consultant Vascular Surgeon, Consultant Nephrologist, Consultant Ophthalmologist, and/ or Consultant Neurologist, (depending on the degree and type of complications). The absence of any documented history of a Consultant 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 operation or procedure, such as a Percutaneous Transluminal Coronary Angioplasty (PTCA), a Coronary Artery Bypass Graft (CABG), angioplasty of peripheral artery, cataract operation, laser treatment for retinopathy, dialysis or renal 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.

General Practitioner Factual report

The Practitioner would normally have made the initial referral of the claimant to the Diabetologist, 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 Diabetologist, and the Specialist Diabetic Nurse, (who are more likely to have detailed knowledge of 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 describes multiple complications for, which factual reports provide inadequate evidence to enable the assessment of functional restrictions; or if it is the only means whereby the claimant’s needs can be clarified.

Medical Services

The 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 2011