The Decision Support Tool (DST) Assessment
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Understanding the Decision Support Tool (DST) Assessment
One of the most critical steps in the NHS Continuing Healthcare journey is the Decision Support Tool (DST) Assessment, which follows a positive outcome from the initial Checklist Assessment. Let us walk you through what to expect, how to prepare, and how ARROW can support you every step of the way. What is the DST Assessment?
The DST Assessment is the second stage in the CHC process. It is conducted by a multidisciplinary team (MDT)—a group of healthcare and social care professionals—who will evaluate whether your loved one qualifies for NHS Continuing Healthcare funding. Once the Checklist Assessment is completed, the local Integrated Care Board (ICB) assigns a case coordinator to manage the process, ensuring all necessary steps are taken to reach a funding decision. You can view a copy of the Decision Support Tool here:
The DST Assessment is meant to take place within 28 days of the Checklist submission, although this timeline can sometimes be expedited if the individual’s condition is deteriorating. You’ll receive advance notice of the assessment date, allowing you the opportunity to prepare thoroughly. How Does the DST Assessment Work? The process begins with the case coordinator assembling the MDT, who will carry out a comprehensive evaluation and complete the DST document. This tool, approved by the NHS, standardises the assessment of eligibility for Continuing Healthcare across England. The team evaluates the individual’s needs across 12 domains of care, such as breathing, mobility, cognition, and communication. They consider the nature, intensity, complexity, and unpredictability of these needs, looking at the overall picture rather than focusing solely on individual scores. At the end of the assessment, the team completes a matrix summarising the scores for each domain. This document forms the foundation of their funding recommendation. Who is Involved in the Assessment? The MDT typically includes two professionals: one from the health side (such as the case coordinator) and another from social care, such as a social worker. Depending on the case, other healthcare professionals—like nurses, therapists, or mental health specialists—may contribute, either in person or by providing supporting evidence. Most importantly, you and your loved one have a right to be involved. If your loved one cannot participate, a family member or representative can attend on their behalf. The National Framework emphasises the importance of family input, so your voice matters during this process. Preparing for the Assessment Preparation is vital to ensuring your loved one’s needs are fully represented. Start by gathering relevant medical records, including GP and hospital notes, care plans, weight charts, and medication records. Review these carefully to understand how they demonstrate the complexity and severity of their care needs. Consider submitting a statement of needs with supporting evidence before the assessment. This can outline specific care requirements and provide valuable context for the MDT. During the meeting, bring a copy of the DST document to follow along, take notes, and ensure all key points are discussed. We strongly recommend having someone accompany you to the assessment. They can take notes, provide moral support, and help ensure no important detail is overlooked. |
What Happens During the DST Assessment?
The DST assessment itself is a structured but collaborative process. The lead practitioner—usually a CHC nurse—will present each domain of care, summarising the evidence available and inviting discussion from the team. You and your family representative will also have the opportunity to contribute, sharing insights about your loved one’s daily needs, behaviours, and challenges. It’s important to remain calm and constructive, even if there are points of disagreement. Remember, the National Framework specifies that family views must be taken into account, and your observations can be pivotal in highlighting aspects of care that may not be immediately apparent in the records. Once all 12 domains have been discussed, the MDT will privately apply the Primary Healthcare Test. This involves analysing the nature, complexity, intensity, and unpredictability of your loved one’s care needs to determine whether they fall under NHS or local authority responsibility. You can learn more about how the DST is assessment is scored in the section below. The Outcome Following the meeting, the MDT makes a recommendation to the ICB, which then reviews and ratifies the decision. This process can take several days or longer. If the patient is found eligible for CHC funding, their care costs will be covered by the NHS, and they will receive a letter confirming the decision and the date of eligibility. If the outcome is unfavourable, don’t lose hope. The decision can be appealed, and eligibility may change over time as needs evolve. Key Considerations and Challenges Families often face hurdles during the DST Assessment, from incomplete documentation to disagreements over scores. If you believe the process hasn’t been followed correctly—for example, if the DST document is presented as complete before the assessment—raise concerns immediately. The National Framework clearly states that the DST must be completed with the individual and their representative’s involvement. How ARROW can help The Decision Support Tool assessment is often challenging for families, particularly where the process feels technical, rushed, or difficult to challenge in real time. At ARROW, we provide practical, evidence-led support at each stage of the DST process. This can include reviewing records in advance, helping families understand how needs should be reflected within the domains, attending the assessment where appropriate, and advising on next steps if the outcome is unfavourable. Our role is to ensure that the assessment is conducted lawfully, that relevant evidence is properly considered, and that health needs are accurately represented. Find out more how ARROW can support you through the Decision Support Tool process as part of our Comprehensive Support Package: |
How is the DST Assessment Scored?
DST Scoring Diagram
This diagram indicates how scoring is achieved. It shows an arrow on the left-hand side going upwards to indicate increasing unpredictability and intensity, and an arrow at the bottom of the diagram which points to two sides to indicate complexity and intensity.
In the middle of the diagram, the 12 domains are included below a table which identifies the different levels of need.
In the middle of the diagram, the 12 domains are included below a table which identifies the different levels of need.
The DST Scoring Diagram
The Decision Support Tool (DST) includes 12 domains—or areas of need—that the multidisciplinary team (MDT) assesses. These domains align with those in the Checklist Assessment, with an additional domain to capture any other significant needs that should be considered.The 12 domains assessed in the Decision Support Tool (DST) process are:
1. Breathing
2. Nutrition
3. Continence
4. Skin Integrity
5. Mobility
6. Communication
7. Psychological and Emotional Needs
8. Cognition
9. Behaviour
10. Drugs, Medication, and Symptom Control
11. Altered States of Consciousness
12. Other Significant Care Needs
In the full assessment, these domains are scored differently to the Checklist. Each domain is rated based on the individual’s level of need, categorised as:
N = No needs
L = Low needs
M = Moderate needs
H = High needs
S = Severe needs
P = Priority needs
The assessment also examines four key characteristics of the individual’s needs:
1) Nature: What the need is and how it manifests.
2) Intensity: The extent of care required to meet the need.
3) Complexity: The interaction of multiple needs and how challenging they are to manage.
4)Unpredictability: The degree to which the needs fluctuate and require urgent or unexpected intervention.
Qualifying for NHS Continuing Healthcare
The National Framework and Decision Support Tool (DST) guidance indicate that an individual may be eligible for NHS Continuing Healthcare (CHC) where their assessed needs include:
These thresholds are often described as indicators of likely eligibility. In practice, however, they do not guarantee a positive outcome.
CHC eligibility is not determined by scores alone. The Multidisciplinary Team (MDT) must consider the totality of the individual’s health needs and apply professional judgement to decide whether those needs amount to a primary health need.
This is the most contested stage of the process. It is here that needs which are clearly health-related in nature are sometimes interpreted, reframed, or downplayed as social care needs. The distinction is subtle but significant, and it sits at the statutory boundary between NHS and local authority responsibility.
The MDT’s Recommendation
At the conclusion of the DST assessment, the MDT produces a summary that includes:
This recommendation is then submitted to the Integrated Care Board (ICB), which is responsible for making the final eligibility decision.
While ICBs are expected to accept the MDT’s recommendation in the majority of cases, they are not legally bound to do so. The ICB may agree with, depart from, or seek further clarification on the recommendation before reaching its decision.
1. Breathing
2. Nutrition
3. Continence
4. Skin Integrity
5. Mobility
6. Communication
7. Psychological and Emotional Needs
8. Cognition
9. Behaviour
10. Drugs, Medication, and Symptom Control
11. Altered States of Consciousness
12. Other Significant Care Needs
In the full assessment, these domains are scored differently to the Checklist. Each domain is rated based on the individual’s level of need, categorised as:
N = No needs
L = Low needs
M = Moderate needs
H = High needs
S = Severe needs
P = Priority needs
The assessment also examines four key characteristics of the individual’s needs:
1) Nature: What the need is and how it manifests.
2) Intensity: The extent of care required to meet the need.
3) Complexity: The interaction of multiple needs and how challenging they are to manage.
4)Unpredictability: The degree to which the needs fluctuate and require urgent or unexpected intervention.
Qualifying for NHS Continuing Healthcare
The National Framework and Decision Support Tool (DST) guidance indicate that an individual may be eligible for NHS Continuing Healthcare (CHC) where their assessed needs include:
- A Priority level of need in certain domains, such as Breathing, Behaviour, Drug Therapies, or Altered States of Consciousness
- A Severe level of need in one domain alongside significant needs in other domains
- A combination of High and/or Moderate needs across several care domains
These thresholds are often described as indicators of likely eligibility. In practice, however, they do not guarantee a positive outcome.
CHC eligibility is not determined by scores alone. The Multidisciplinary Team (MDT) must consider the totality of the individual’s health needs and apply professional judgement to decide whether those needs amount to a primary health need.
This is the most contested stage of the process. It is here that needs which are clearly health-related in nature are sometimes interpreted, reframed, or downplayed as social care needs. The distinction is subtle but significant, and it sits at the statutory boundary between NHS and local authority responsibility.
The MDT’s Recommendation
At the conclusion of the DST assessment, the MDT produces a summary that includes:
- A breakdown of scores across all care domains
- A narrative summary of the individual’s needs and how they interact - the 'Primary Health Need Test"
- A recommendation as to whether CHC eligibility is indicated
This recommendation is then submitted to the Integrated Care Board (ICB), which is responsible for making the final eligibility decision.
While ICBs are expected to accept the MDT’s recommendation in the majority of cases, they are not legally bound to do so. The ICB may agree with, depart from, or seek further clarification on the recommendation before reaching its decision.
After the Assessment
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The ICB’s Written Decision
Once the assessment is complete, the ICB will provide a written decision that includes:
If you disagree with the ICB’s decision, you have the right to appeal. Appeals must be submitted in writing within six months of receiving the decision. Next Steps If the assessment is successful: The individual qualifies for CHC funding. The NHS will then take responsibility for covering the full cost of their care, including accommodation and related social care needs. If the assessment is unsuccessful: If the individual’s care needs are deemed not to be primarily health-related, responsibility for their care will transfer to the Local Authority (Social Services). Local Authority care is means-tested, so the cost will depend on the individual’s financial situation. Even if CHC funding is denied, the DST assessment can serve as a useful baseline for future reassessments, particularly if the individual’s condition changes. In such cases, a new assessment can be requested. Additionally, the individual should have their nursing needs assessed to determine if they qualify for NHS-funded Nursing Care. Get in touch to discuss how ARROW can support you through the Decision Support Tool process: |
