Home › The Decision Support Tool
The DST is the national form a multidisciplinary team completes at a full assessment. Most Continuing Healthcare cases are won or lost on how honestly it is filled in — which is why it is worth understanding exactly how it works.
Every domain is rated on a scale. Not all domains reach every level — several stop at High, and only a few go to Priority.
There is no total that automatically qualifies. National guidance indicates that one Priority rating, or two or more Severe ratings across different domains, would usually point towards eligibility — and a combination of High ratings can also qualify.
But the framework requires a professional judgement on the totality of needs, weighed against four characteristics: nature, intensity, complexity and unpredictability. These are analytical tools, not four separate hurdles, and they must be considered in the round. An assessment that treats the domain scores as the end of the inquiry is open to challenge on exactly that basis.
| Domain | What moves it up a level |
|---|---|
| Breathing | What moves it upOxygen, suction, airway management, ventilatory support. Also where anxiety or infection reliably worsens breathlessness and staff must monitor through it. |
| Nutrition | What moves it upModified or thickened diets, swallowing difficulty, tube feeding, and monitored intake where targets are repeatedly not met. Needs a dated MUST score and weight trajectory to carry weight. |
| Continence | What moves it upFrequency and staffing of interventions, catheter or stoma care, recurrent infections, and distress triggered by personal care. Volume of repeated intervention through day and night supports Intensity. |
| Skin and tissue viability | What moves it upActual pressure damage or wounds, repositioning regimes, moisture-related damage, and specialist tissue viability involvement. |
| Mobility | What moves it upNumber of carers per transfer, hoist or stand-aid use, falls history, sensor mats and low beds. Strongest where the person attempts to move despite being unable to do so safely. |
| Communication | What moves it upInability to reliably convey pain or need. Verbal speech is not the same as reliable communication — someone who calls for help and then says she is fine is not communicating need reliably. |
| Psychological and emotional | What moves it upDocumented distress, anxiety, hallucinations or delusional beliefs requiring repeated staff intervention. Needs to appear in the records, not only in family accounts. |
| Cognition | What moves it upLoss of awareness of risk and inability to make safe decisions. The critical evidence is not the diagnosis but what the impairment causes the person to do. |
| Behaviour | What moves it upFrequency, predictability and risk. ABC charts are the key evidence. Behaviour that creates physical danger — resisting care, unsafe attempts to stand — carries more weight than shouting alone. |
| Drug therapies | What moves it upComplexity of the regime and genuine monitoring requirements. An instruction to check a pulse before administering and withhold below a threshold is a real monitoring need, not routine administration. |
| Altered consciousness | What moves it upSeizures, blackouts or collapses, their frequency, and the intervention each demands. |
| Other significant needs | What moves it upAn open domain for anything significant that does not fit the other eleven. |
Needs must be recorded at the level they would be without the care currently in place. Care records are full of entries saying someone was settled — and assessors read those as low need.
They are the opposite. The right question is not whether she was settled, but what had to happen for her to be settled. The low bed. The sensor mat. Two carers for every transfer. The hoist standing ready. Medication administered on schedule. Strip those away and the need is plainly visible. A well-managed need is still a need, and under-scoring it is the most common reason a claim fails when it should have succeeded.
This is where most assessments go wrong, and where most successful appeals focus.
Take a person who cannot transfer safely. On its own that is a Mobility issue. Now add cognitive impairment that removes her awareness of danger, so she repeatedly tries to stand anyway. And add distress during assistance, so she resists the carers helping her.
Read as three separate boxes, that is a moderate score in each. Read properly, it is a person generating continuous, unpredictable risk that demands sustained supervision, two-person assistance, contingency equipment and a skilled behavioural response. That is Complexity and Unpredictability — and it is invisible to anyone filling in twelve boxes independently.
Care record systems print today's data onto historic reports. A report covering a period two years ago may carry a nutrition score or risk banner generated on the day it was printed. Those current fields prove nothing about the period being assessed.
It cuts both ways. A dated care plan entry, a dated daily note, a dated ABC chart from within the period carries real evidential weight. An undated dashboard field from a report run last week does not. Knowing which is which is often the difference between a submission that persuades and one that gets taken apart.
Send us the Decision Support Tool and the decision letter. We will review them free of charge and tell you honestly whether there are grounds.
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