Daily evidence
Care notes and night records
Use records showing frequency, intervention, risk and what actually happened across ordinary days and nights.
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Full NHS Continuing Healthcare assessment
What is the NHS Continuing Healthcare Decision Support Tool?
The Decision Support Tool (DST) is the national framework used by a multidisciplinary team to record needs across 12 care domains and support a recommendation on whether the person has a primary health need. It is not a simple points calculator: the overall nature, intensity, complexity and unpredictability of needs still have to be considered.
Reviewed by Paris Theodorou, Solicitor & Principal · Theodorous · SRA 809508 · Updated 17 September 2026
How is the DST scored?
Each domain is described using levels such as No Needs, Low, Moderate, High, Severe and, in some domains, Priority. Not every domain uses every level. The levels help structure the evidence, but the assessment remains a professional judgement on the person’s overall needs.
What are the 12 CHC care domains?
Breathing. Respiratory support, monitoring and the consequences of deterioration.
Nutrition. Eating, drinking, swallowing, weight and assisted or artificial feeding.
Continence. Bladder and bowel needs, interventions and associated risks.
Skin and tissue viability. Pressure damage, wounds, repositioning and specialist input.
Mobility. Transfers, falls risk, equipment and the support required to move safely.
Communication. Ability to reliably communicate needs, pain and distress.
Psychological and emotional needs. Anxiety, distress, hallucinations and other emotional or mental-health needs.
Cognition. Understanding, memory, awareness of risk and decision-making.
Behaviour. Frequency, severity, risk and predictability of behaviours requiring intervention.
Drug therapies and medication. Complexity, monitoring and risks associated with medicines or treatments.
Altered states of consciousness. Seizures, blackouts or other episodes and the response required.
Other significant care needs. Important needs that do not fit comfortably within the other domains.
Why can domain-by-domain scoring miss the real picture?
Because needs can interact. A mobility problem may look moderate by itself. Add severe cognitive impairment that removes awareness of danger, repeated unsafe attempts to stand and distress when carers intervene, and the resulting care requirement may be materially more complex and unpredictable than any one box suggests.
This is why the primary health need analysis matters after the domain levels are recorded.
Do well-managed needs still count in the DST?
Yes. A need should not be marginalised merely because good care is successfully controlling it. The evidence should explain what staff, medication, equipment or supervision are doing to prevent deterioration or incidents. See our detailed guide to well-managed needs.
What evidence should be checked against the DST?
Plans and risks
Care plans and risk assessments
Check staffing levels, equipment, supervision and contingency planning against the level recorded in the DST.
Clinical evidence
Medication and professional records
Look for monitoring requirements, treatment changes, GP or specialist input and clinical escalation.
Behaviour and cognition
ABC charts, incidents and capacity evidence
These can show the frequency, triggers, risks and practical consequences of cognitive or behavioural needs.
What if the person has dementia?
A dementia diagnosis does not automatically qualify someone for CHC, but cognition, behaviour, communication and mobility can interact in ways that are easy to understate when each domain is viewed separately. See our guide to dementia and NHS Continuing Healthcare.
What if the DST appears wrong?
Compare the recorded levels and narrative with the underlying evidence, then examine whether the overall recommendation properly addresses the primary health need test. If the final decision is negative and the evidence or reasoning does not align, see how to appeal an NHS Continuing Healthcare decision.
Use the DST as part of the wider evidence chain
The full-assessment cluster
CHC ChecklistThe screening stage that usually comes before a full assessment.Primary health needThe test the DST evidence ultimately has to answer.Well-managed needsWhy successful care should not automatically reduce the underlying need.Dementia and CHCHow cognition, behaviour and mobility can compound risk.Appealing a CHC refusalHow to challenge scoring, evidence and overall reasoning.CHC funding withdrawnWhat to examine when an existing award is removed or reduced.How to prepare for a CHC assessmentRecords to gather, who can attend and how to present needs, risks and well-managed care.What evidence and records should you gather?Care notes, medical records, risk assessments, medication, incidents and other evidence explained.