What is the Decision Support Tool (DST)?

The DST is a national document developed by the Department of Health & Social Care. This DST must be completed by a multidisciplinary team (MDT) when they assess eligibility for NHS Continuing Healthcare Funding.

The DST is different to the NHS Checklist, which is the screening tool used to determine who needs an eligibility assessment. It is usually completed for those who have passed the Checklist threshold, at the point that their eligibility is being fully considered.

If an NHS Checklist has not yet been completed for an individual, then you may wish to read about the Checklist first.

The DST is not an eligibility assessment in itself. The MDT completes it to ensure that a comprehensive needs assessment is carried out and a recommendation on eligibility for NHS Continuing Healthcare can be made. 

The DST can be viewed here.

The MDT should meet certain requirements. Together, they should undertake the needs assessment, complete the DST, and make a recommendation on eligibility for NHS Continuing Healthcare.

At an absolute minimum, the MDT should comprise two professionals from different healthcare professions. This is not ideal, and best practice is one qualified health professional and one qualified social care professional.

The MDT should be knowledgeable about the individual’s needs where possible. It may be sensible for other professionals, such as a nurse employed by the care home, to participate on the MDT alongside the nurse and social care professionals.

Continuing Healthcare assessment procedure is complex. The MDT should follow best practice as set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. It provides some clarity on how the DST should be completed.

The DST contains 12 areas of need (known as “care domains”).

The 12 care domains are:

1. Breathing
2. Nutrition – Food and Drink
3. Continence
4. Skin and tissue viability
5. Mobility
6. Communication
7. Psychological and Emotional needs
8. Cognition
9. Behaviour
10. Drug Therapies
11. Altered States of Consciousness
12. Other Significant Care Needs

Each domain has a series of descriptions of need which correspond with a series of levels. These are based on the severity of the need being considered.

The levels of need are “No Needs” at their lowest level, rising to “Low”, “Moderate” and “High”. In certain care domains, there may also be “Severe” and “Priority” levels.

The completion of the DST requires a “person-centred” approach. This means that the individual (where they have the capacity to consent) or their representative (where they do not) should be invited to participate fully in all stages of the assessment process. The MDT should carefully consider the individual's (or their representative's) views in the same way that it would other evidence of need.

If you need help to contribute effectively to a Continuing Healthcare assessment, Winston Solicitors can provide you with support. We can help you to prepare for your assessment or provide legal representation to support you at the meeting.

Once the MDT have gathered comprehensive information and evidence and agreed the levels of need in each of the 12 care domains, they must exercise their professional judgment. This will assess the overall level of need and come to a recommendation as to whether the individual has a Primary Health Need.

The MDT must consider whether the nursing or other health services required by the individual are:

1. more than incidental or ancillary to the provision of accommodation which a social services authority is, or would be but for a person's means, under a duty to provide; or
2. of a nature beyond which a social services authority whose primary responsibility is to provide social services could be expected to provide.

The MDT must decide whether the person’s healthcare needs go beyond what social services would normally provide. If the required nursing or medical care is more than just an additional support to accommodation, or if it’s outside what social services are expected to cover, the individual may be eligible for NHS Continuing Healthcare.

If the MDT recommends that they are when considering the needs in their totality, it must recommend that the individual has a Primary Health Need.

The National Framework explains that the nature, intensity, complexity and unpredictability of an individual’s needs are key. These may help to determine whether the nursing or other health services are more than the limits of a local authority’s responsibilities. They are known as the four key characteristics.

The MDT’s recommendation should include a summary of the individual’s needs and how the four key characteristics apply to them. This is irrespective of whether the recommendation is that the person is eligible or not.

The eligibility recommendation should not be based on factors such as how well the care provider is managing the needs, the type of care setting in which the care is provided, or whether the care is being provided by a healthcare professional.

The eligibility decision rests with the Integrated Care Board (“ICB”) and it should be based on the recommendation made by the MDT. The ICB should accept the MDT’s eligibility recommendation in all but exceptional circumstances. The eligibility decision should be communicated in writing to the individual or their representative.

The ICB is legally responsible for arranging, maintaining and funding the package of care.

The ICB should provide written confirmation of the decision, the right to seek a review of it, and a copy of the DST.

The legal implication of the decision is that responsibility for the care package remains with the local authority, which provides funding a means-tested basis.

You may want to obtain professional advice to ascertain whether there is merit in pursuing an appeal against the decision. At Winston Solicitors we can provide this service.

An appeal against an ineligibility decision should be made within 6 months of the date of the decision letter, so it’s important to obtain advice promptly.