Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
3. R (Grogan) v Bexley NHS Care Trust and others [2006] EWHC 44 (Admin).
4. Social Work England. Professional standards. Available at: https://www.socialworkengland.org.uk
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide sets out a method for auditing a completed NHS Continuing Healthcare Decision Support Tool. It covers assembling the documents, reading each domain against its narrative, testing for well-managed need, checking the characteristics analysis, identifying gaps and blank domains, comparing the tool against the care records, and converting findings into a structured challenge.
How to audit a completed Decision Support Tool
Reading a completed Decision Support Tool with a method finds more than reading it with a grievance. This is the sequence we use, and it can be followed by anyone with the papers in front of them.
Assemble the documents
You need the completed tool, the multidisciplinary team recommendation, the written decision with reasons, and the care records covering the same period. Without the records you can find internal inconsistencies but you cannot show that anything was missed. Request all of them in writing before starting.
Read each domain against its own narrative
Work through one domain at a time. Read the narrative, ignore the level, and form your own view of what that narrative describes. Then look at the level recorded. Where your view and the recorded level differ, note the domain and why. This is the fastest route to the strongest points, and it needs nothing beyond the document.
Test every domain for well-managed need
For each domain, ask whether the narrative describes the need or the managed outcome. Phrases such as settled, stable, intact, controlled and no concerns are the markers. Where you find one, ask what produces that outcome, and whether the tool records the regime as well as the result.
Check the characteristics analysis
Find where nature, intensity, complexity and unpredictability are addressed. Ask whether each is reasoned against the recorded needs or simply named. Complexity should identify interacting needs. Unpredictability should identify dated events and the warning available. Assertion without analysis is a specific defect.
Look for what is absent
Blank or single line domains. Any domain where night time needs are not mentioned. Absence of fluctuation anywhere in the document. No reference to care records. No social care input on the attendance list. Absence is harder to spot than error, which is why it is worth a separate pass rather than being noticed in passing.
Compare against the care records
This is the slowest step and usually the most productive. Take the domains you have flagged and find records that contradict or expand the narrative. Note dates and page references. Incident logs, night records and repositioning charts frequently show a very different picture from the summary written in a meeting.
Convert findings into a submission
Produce a numbered list. For each point, state the domain, what the tool records, what you say the position is, and the evidence with dates. Add a separate section for procedural defects. Lead with your two or three strongest domains, because reviewers work through a lot of material.
Key takeaway
Work domain by domain, form your own view before reading the level, test everything for well-managed need, do a separate pass for what is absent, then check the flagged domains against the records. Finish with a numbered list rather than a narrative.
Add a Title
Add paragraph text. Click “Edit Text” to update the font, size and more. To change and reuse text themes, go to Site Styles.
Frequently asked questions
What do I need before starting?
The completed Decision Support Tool, the recommendation, the written decision with reasons, and the care records for the same period. Request all of them in writing.
What should I look for first?
Read each domain narrative and form your own view before looking at the level recorded. Where the two differ, you have a point that can be made from the document alone.
How do I spot well-managed need?
Look for words like settled, stable, intact, controlled and no concerns. Each describes an outcome. Ask what produces it and whether the tool records that regime as well as the result.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.