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NHS Continuing Healthcare
The Decision Support Tool and the 12 Care Domains
How the DST scores needs, and why the domain language matters
What is the Decision Support Tool?
The Decision Support Tool is the document a multidisciplinary team uses to score a person's needs across twelve care domains during a full NHS Continuing Healthcare assessment. The DST informs the eligibility judgement; it does not replace it. The deciding question remains whether the person's overall needs amount to a primary health need.
Plain English
For families and professionals
England and Wales
National coverage
Registered professionals
Written and reviewed
Families often meet the DST for the first time in the meeting itself, which puts them at an immediate disadvantage: the tool has its own language, and needs that are not described in that language can be under-scored. This guide describes the system in England. Wales operates its own Continuing NHS Healthcare framework through health boards.
When the DST is used
The DST is completed at the full assessment stage, which follows:
- A positive Checklist screening
- A challenge or review where the needs picture must be re-scored
- A reassessment where the person's needs have changed
How to prepare
Before the DST meeting:
- Read the care records and note where daily reality is not written down
- Prepare examples for each area of need: what happens, how often, what it takes to manage
- Note fluctuation honestly: the bad days matter as much as the good ones
- Ask who will be at the meeting and how the person and family views will be recorded
- Ask for a copy of the completed DST afterwards
Where people often go wrong
- Treating the DST as arithmetic, as if scores alone decide the outcome
- Accepting domain scores that do not match what the records show
- Presenting a well-managed need as no need at all: a well-managed need is still a need
- Relying on diagnosis labels instead of describing what the needs actually involve
- Leaving the meeting without knowing what was recorded
- Treating the DST as arithmetic, as if scores alone decide the outcome
- Accepting domain scores that do not match what the records show
- Presenting a well-managed need as no need at all: a well-managed need is still a need
- Relying on diagnosis labels instead of describing what the needs actually involve
- Leaving the meeting without knowing what was recorded
How the scoring works
The multidisciplinary team considers the person's needs domain by domain and records a level of need in each. The completed tool supports a recommendation on whether the person has a primary health need, judged by the nature, intensity, complexity and unpredictability of their needs taken as a whole.
A clear recommendation of eligibility is expected where the levels of need are at the highest end of the tool, including a priority level of need in a domain that carries one, or severe needs in more than one domain. Below that, the overall picture across the domains, and how the needs interact, carries the judgement.
A social work led multidisciplinary practice
Nellie Supports is a social work led multidisciplinary specialist practice working across England and Wales, operating through a permanent, full-time employed team that has completed more than 11,000 assessments. Our NHS Continuing Healthcare work prepares and presents the evidence of need at every stage of the process.
Frequently Asked Questions
Who completes the Decision Support Tool?
The multidisciplinary team completing the full assessment. The person and their family should have their views recorded as part of it.
Can the family contribute to the DST?
Yes. Family and carer evidence about day-to-day needs is exactly what stops the tool being completed on an incomplete picture.
What if we disagree with the scores?
Ask for the completed DST, compare it against the care records, and note each domain where the score does not match the evidence. Those domains become the substance of a challenge.
This guide is general information about NHS Continuing Healthcare in England, not legal advice, and does not create a professional relationship. Nellie Supports provides independent social work assessment, evidence and advocacy support. We do not provide regulated legal advice, and where a legal remedy is needed we will say so and support your solicitor's work.