DECISION SUPPORT

What is the DST? 

The Decision Support Tool (DST) is not another assessment on its own , it is a tool which captures key information and sets out the evidence in a detailed needs-based format. 

A DST is completed following a positive Checklist, i.e. where the outcome of the Checklist is that full consideration of eligibility for CHC is required (a positive checklist), or following a direct referral correctly identifying that the individual requires full consideration of eligibility. 

It is important to check whether the individual has consented to the eligibility consideration process and to encourage the full participation of the individual and family/representative in the process if this is agreed by the individual. The DST should be completed by the MDT, drawing on assessments by professionals who have direct knowledge of the individual and their needs.

What evidence is required? 

The DST should draw on health and social care assessments (and other relevant information) which reflect the individual's current needs. It is designed to collate and present the information on the individual’s needs in a consistent way which assists decision-making.

How should meetings be recorded? 

The DST provides a framework to bring together and record the needs of the individual in 12 care domains. The information presented must be a clear reflection of the individual's current needs.

What to do if the MDT cannot agree?

For each domain, MDTs are asked to identify which descriptor level most closely matches the individual's needs. Where the MDT is unable to agree, despite discussion and careful re-examination of the evidence (or seeking further evidence), the higher level of need should be allocated, but there should be clear, reasoned evidence to support this. If following further discussion, a level of need cannot be agreed then the MDT members should articulate their rationale for reaching the level of need they have, and this should be clearly recorded on the DST 

Those completing the DST must use their professional judgement to justify how and why a recommendation is made and record that recommendation with due regard to the 12 care domains and 4 key characteristics that are discussed later in this session.

MDTs are required to make a recommendation as to whether the individual has a 'primary health need' and is therefore eligible for NHS Continuing Healthcare. This should take into account the range and levels of need recorded in the DST and include consideration of the nature, intensity, complexity and/or unpredictability of the individual's needs. Each of these characteristics may, in combination or alone, demonstrate a 'primary health need', because of the quality and/or quantity of care required to meet the individual's needs.

Although the tool supports the process of determining eligibility and ensures consistent and comprehensive consideration of an individual’s needs, it cannot directly determine eligibility. Indicative guidelines as to threshold are set out in the tool (for example, if one area of need is at Priority level, then this demonstrates a primary health need), but these are not to be viewed prescriptively. Professional judgement should be exercised in all cases to ensure that the individual's overall level of need is correctly determined.

At the end of the DST, there is a summary sheet to provide an overview of the levels chosen and a summary of the individual's needs, along with the MDT's recommendation about eligibility or ineligibility. A clear recommendation (and decision) of eligibility for NHS Continuing Healthcare would be expected in each of the following cases:

• A level of priority needs in any one of the four domains that carry this level

• A total of two or more incidences of identified severe needs across all care domains

Where there is either:

• A severe level need combined with needs in a number of other domains or

• A number of domains with high and/or moderate needs. This may also, depending on the combination of needs, indicate a 'primary health need' and therefore careful consideration needs to be given to the eligibility recommendation and clear reasons recorded if the recommendation is that the person does not have a 'primary health need'

See the table below  for the 12 domains considered with guidance to the type of information and evidence that is required in each domain. 

Key points 

• Remember it is important to check whether the individual has consented to the eligibility consideration process and to encourage the full participation of the individual and family/representative in the process, where appropriate

• The individual and/or their family or representative should be involved in the completion of the DST and should have the opportunity to agree the accuracy of the information recorded in each domain of the DST

• The DST should be completed by an MDT, drawing on assessments by professionals who have direct knowledge of the individual and their needs