The Decision Support Tool (DST) – used in NHS continuing healthcare funding decisions – is a document which helps to record evidence of an individual’s care needs to determine if they qualify for continuing healthcare funding.
As the Decision Support Tool (DST) fits into the continuing healthcare decision-making process, it is important to understand the procedure in its entirety to fully appreciate the importance of the DST.
The Continuing Healthcare Process
The first step for most individuals will involve a healthcare professional using the continuing healthcare checklist to decide whether it is appropriate to undertake a full NHS continuing healthcare assessment. It is important to note that this initial checklist does not decide if an individual is eligible for funding, only whether they should be recommended for a full continuing healthcare assessment, as evidenced by the National Framework for NHS continuing healthcare (2012):
It is necessary to ensure that the individual and (where appropriate) their representative understand that the Checklist does not necessarily indicate that the individual will be eligible for NHS continuing healthcare – only that they are entitled to consideration for eligibility.
If the checklist identifies the need to carry out a full assessment, your Integrated Care Board (ICB) will be contacted. The full assessment is carried out by a multi-disciplinary team comprising two or more health or social care professionals familiar with your needs. In some cases, the multi- disciplinary team will contact the specialists involved with your care to build a better picture of your needs.
The information gleaned from your full assessment will be used by the multi- disciplinary team to complete a ‘Decision Support Tool’ (DST). The DST document was developed to ensure assessments are carried out as consistently as possible across the national NHS network.
The 12 Areas of Need in the Decision Support Tool
The DST identifies twelve areas of need or ‘domains’ – 11 specific domains and an additional domain for recording needs that don’t immediately fit into the other 11.
The National Framework states:
In certain cases, an individual may have particular needs that are not easily categorised by the care domains described here. In such circumstances, it is the responsibility of the assessors to determine the extent and type of the need and take that need into account (and record in the 12th care domain) when deciding whether a person has a primary health need.
Each domain is divided into levels of need from: ‘no need’, ‘low’, ‘moderate’, ‘high’, ‘severe’ and ‘priority’. The levels reflect the nature, intensity, complexity and unpredictability of a need.
- behaviour (e.g. aggression or lack of inhibition)
- cognition
- psychological and emotional needs (e.g. hallucinations or anxiety)
- communication
- mobility (e.g. risk of falls, inability to bear their own weight)
- nutrition – food and drink (e.g. difficulty swallowing)
- continence
- skin – including tissue viability (e.g. pressure ulcers)
- breathing (e.g. emphysema or chest infection)
- drug therapies and medication: symptom control
- altered states of consciousness (e.g. coma)
- other significant care needs.
The multi-disciplinary team will allocate a level of need to each care domain to determine if the individual has a ‘primary health need’ and then make a recommendation to the ICB as to whether the individual should be entitled to NHS continuing healthcare.
A clear recommendation of eligibility would be expected if the individual undergoing assessment has:
- priority level of need in any of the four
- two or more instances of severe needs across all domains
If the following apply, this may, depending on the combination of needs, also indicate a primary health need:
- one domain recorded as severe together with needs in a number of other domains, or
- a number of domains with high and/or moderate needs.
Some commonly asked questions
Q. What happens if we are appealing a DST decision and the patient dies before the outcome of the appeal?
A. Absolutely nothing, the case will continue even if the person passes away in the meantime.
Q. What happens if patient dies after a checklist is completed, but before a DST?
A. A DST will still be completed by the multi-disciplinary team in accordance with the National Framework.
Q. What happens if patient dies before a checklist or DST is completed?
A. We (at Compass CHC) request that the NHS continuing healthcare team complete a retrospective review on the patient.
How can Compass CHC help?
If you have significant ongoing health needs we, Compass CHC, can help you obtain NHS continuing healthcare funding. We assist people with continuing healthcare funding applications, recovering retrospective fees and, where applicable, initiating appeals. Our team at Compass CHC consists of lawyers (non-practising) and clinicians (including nurses, tissue viability specialists and pharmacists) whose expertise ensures we are able to understand the nuances and complexities of each case.
Compass CHC has helped hundreds of individuals and their families understand and receive NHS continuing healthcare funding. Complete our free, confidential assessment today and an expert member of our team will contact you for a no obligation discussion to outline your options.
Author: Tim Davies LLB
