Understanding the CHC DST Assessment

Understanding the NHS CHC Decision Support Tool

The Decision Support Tool (DST) is the formal assessment document used by NHS Multi-Disciplinary Teams to evaluate whether someone qualifies for NHS Continuing Healthcare. It is more detailed than the initial CHC Checklist and covers 12 care domains, each scored across multiple levels from No Needs through to Priority. The DST does not make the final decision automatically. Instead, it supports the MDT in reaching a recommendation, which is then reviewed by the Integrated Care Board.

Families and carers have the right to be present during the DST assessment, to contribute evidence, and to challenge scores they believe do not accurately reflect the person's needs. Understanding how each domain is scored is one of the most important ways to ensure a fair outcome.

How to Use This Guide

This guide walks through each of the 12 DST domains in plain English. For every domain you will find a description of what the MDT is looking for, the scoring levels available, and practical tips on what evidence is most useful to present. The domains cover a wide range of needs including behaviour, cognition, communication, continence, skin integrity, mobility, nutrition, and medication.

Use this guide before the assessment to understand the process, during the assessment to follow along and raise concerns, and after the assessment to understand any scores you wish to challenge. The guide is based on the 2022 revised edition of the NHS National Framework for NHS Continuing Healthcare.

What scores are needed to qualify for CHC?

There is no simple pass mark. The MDT considers the overall picture rather than applying a points threshold. However, having at least one Priority level score in any domain creates a strong indicator for CHC eligibility, as does having two or more Severe scores. The DST also considers whether needs are intense, complex, unpredictable, or require specialist management that goes beyond what a care home or home care agency would ordinarily provide.

What if the DST recommends against CHC?

A negative recommendation can be challenged. The first step is local resolution, where you request a review meeting with the ICB. If that does not resolve the dispute, you can escalate to an Independent Review Panel within six months of the original decision. Around 13 to 25 percent of appeals at local resolution result in a CHC award, so it is always worth pursuing if you believe the assessment did not accurately capture the full extent of needs.