The CHC Decision Support Tool (DST), used in NHS Continuing Healthcare funding decisions, is a document that assists in assessing eligibility by evaluating 12 domains of need, such as behaviour, mobility, and cognition to determine whether an individual qualifies for continuing healthcare funding.
As an important part of the continuing healthcare decision-making process, we’ve put together this guide to help you understand how it fits in the process.
The continuing healthcare process
The first step for most individuals will involve a healthcare professional using the continuing healthcare checklist to determine whether a full NHS Continuing Healthcare assessment is appropriate. It is important to note that this initial checklist does not decide if an individual is eligible for funding, it only indicates whether they should be recommended for a full continuing healthcare assessment. The National Framework for NHS continuing healthcare (2012) states:
“It is necessary to ensure that the individual and (where appropriate) their representative understand that the Checklist does not necessarily indicate that the individual will be eligible for NHS continuing healthcare – only that they are entitled to consideration for eligibility.”
If the checklist identifies the need to for a full assessment, your Integrated Care Board (ICB) will be contacted. The full assessment is carried out by a multidisciplinary team of two or more health and social care professionals who are familiar with your needs. In some cases, the multidisciplinary team will contact the specialists involved with your care to build a better picture of your needs.
The information gleaned from your full assessment will be used by the multidisciplinary team to complete a Decision Support Tool. The DST document was developed to ensure assessments are carried out as consistently as possible across the national NHS network.
The 12 areas of need in the Decision Support Tool
The DST identifies 12 areas of need or ‘domains’ – 11 specific domains and an additional domain for recording needs that don’t immediately fit into the other 11.
The National Framework states:
“In certain cases, an individual may have particular needs that are not easily categorised by the care domains described here. In such circumstances, it is the responsibility of the assessors to determine the extent and type of the need and take that need into account (and record in the 12th care domain) when deciding whether a person has a primary health need.”
Each domain is divided into levels of need from: ‘no need’, ‘low’, ‘moderate’, ‘high’, ‘severe’ and ‘priority’. The levels reflect the nature, intensity, complexity and unpredictability of a need.
The 12 domains of continuing healthcare are:
- Behaviour (e.g. aggression or lack of inhibition)
- Cognition (e.g. memory loss)
- Psychological and emotional needs (e.g. hallucinations or anxiety)
- Communication (e.g. limited ability to express needs verbally)
- Mobility (e.g. risk of falls, inability to bear their own weight)
- Nutrition – food and drink (e.g. difficulty swallowing)
- Continence e.g. urinary or bowel incontinence)
- Skin – including tissue viability (e.g. pressure ulcers)
- Breathing (e.g. emphysema or chest infection)
- Drug therapies and medication: symptom control (e.g. complex medication regimes needing medical supervision)
- Altered states of consciousness (e.g. coma)
- Other significant care needs.
Learn more: What are the 12 care domains for CHC?
The multidisciplinary team will allocate a level of need to each care domain to determine if the individual has a ‘primary health need’ and then make a recommendation to the ICB as to whether the individual should be entitled to NHS Continuing Healthcare.
A clear recommendation of eligibility would be expected if the individual undergoing assessment has:
- priority level of need in any of the four domains
- two or more instances of severe needs across all domains.
If the following apply, this may, depending on the combination of needs, also indicate a primary health need:
- one domain recorded as severe together with needs in a number of other domains, or
- a number of domains with high and/or moderate needs.
Frequently asked questions about the Decision Support Tool
What happens if we are appealing a DST decision and the patient dies before the outcome of the appeal?
Absolutely nothing, the case will continue even if the person passes away in the meantime.
What happens if patient dies after a checklist is completed, but before a DST?
A DST will still be completed by the multidisciplinary team in accordance with the National Framework.
What happens if patient dies before a checklist or DST is completed?
We would request on your behalf that the NHS Continuing Healthcare team complete a retrospective review on the patient.
Unsure if you or a loved one qualifies?
If you think you or a loved one may be eligible for CHC funding, don’t delay. We’re here to guide you through every step.
Submit an enquiry to get started.
