Nellie Supports · NHS Continuing Healthcare
CHC Assessment Support: DST and MDT Meeting Representation
Go into the CHC assessment with organised evidence and support to explain the person's needs. We prepare for the Decision Support Tool and represent those needs at the multidisciplinary team meeting. £5,820 including VAT for new clients, including the independent assessment and care plan; £4,500 including VAT for eligible existing cases. Travel is charged separately.
Service overview
Go into the CHC assessment with organised evidence and support to explain the person's needs. We prepare for the Decision Support Tool and represent those needs at the multidisciplinary team meeting. £5,820 including VAT for new clients, including the independent assessment and care plan; £4,500 including VAT for eligible existing cases. Travel is charged separately.
All travel is charged separately at £48 per hour including VAT (£40 excluding VAT). The travel cost and any additional work are confirmed in your written quotation before booking.
Evidence preparation and representation at the CHC multidisciplinary team meeting in England.
New clients: £5,820 including VAT
Meeting booked: Tell us the date
Cover throughout the country: England
Registered professionals: Social work led
At a glance
Role
Evidence preparation and representation at the meeting where the DST is completed.
Framework
National Framework for NHS CHC and NHS-funded Nursing Care, 2022 revision
Format
Relevant records review, evidence preparation and agreed meeting attendance.
Deliverable
Written evidence, meeting representation and an account of the next steps.
Coverage
England only. Wales has a separate Continuing NHS Healthcare framework.
Who are you arranging this for?
We agree how the person will be involved, who can instruct us and who should receive updates.
I am supporting a family member
You have someone to explain the process, organise the relevant evidence and help you put the person's needs into words. The work and fee are agreed before we start.
I am instructing as a professional
We agree the instruction, authority to act, evidence required, reporting arrangements and timetable with you. Written work links each point to its source.
What DST and MDT meeting support is
Nellie Supports is an independent social work practice. Our NHS Continuing Healthcare support helps families and professionals in England explain care needs and present relevant evidence.
What DST and MDT meeting support is
Practical preparation and representation for the full CHC assessment, with the person's everyday needs at the centre.
A multidisciplinary team brings together assessed health and social care needs using the DST. It considers twelve care domains and recommends whether the person has a primary health need.
We organise the relevant records, prepare written representations and attend the agreed meeting to explain the evidence and raise any material differences.
When you need DST and MDT meeting support
A positive Checklist normally leads to full assessment. Some cases go directly to full assessment. The DST supports professional judgement; it is not a funding application that succeeds on a points total.
Support can help when the records are extensive, needs fluctuate or you want someone alongside you to explain the care picture.
A DST or MDT meeting has been booked
You have a date and want the evidence ready before it.
You are attending alone
You would like help explaining the person's needs and responding to questions.
The Checklist was positive
You want to prepare for the next assessment stage and understand how the NHS reaches its decision.
The care record is thin
What the person needs has never been written down properly.
Needs fluctuate
A settled presentation does not explain all the care and monitoring needed.
A previous DST went badly
You are being reassessed at a new MDT meeting and want it done differently this time.
The twelve care domains the Decision Support Tool scores
The twelve domains have different available levels. We match evidence to the relevant descriptors and consider the total needs through nature, intensity, complexity and unpredictability. Scores inform the judgement; they are not added up to decide funding.
Breathing
Nutrition, food and drink
Continence
Skin integrity, including wounds, ulcers and tissue viability
Mobility
Communication
Psychological and emotional needs
Cognition
Behaviour
Drug therapies and medication, including symptom control
Altered states of consciousness
Other significant care needs
The scores inform the decision, they do not make it
The assessment must consider the whole picture, including how needs interact. Domain levels are important evidence, but do not replace the primary health need judgement.
A good day is not the whole picture
Care notes, incident records and family accounts help explain changes, night-time support and the interventions needed to keep the person well.
The framework for the DST and MDT assessment
NHS Continuing Healthcare in England is governed by the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, in its 2022 revision. Eligibility turns on whether the person has a primary health need.
A primary health need is judged by the nature, intensity, complexity and unpredictability of the person's overall needs. The Decision Support Tool (DST) completed by the multi-disciplinary team informs that judgement; it does not replace it.
Framework: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2022 revision); the primary health need test; Integrated Care Board decision-making
Read the supporting guidance
Nature of the person's needs
Intensity of the person's needs
Complexity of the person's needs
Unpredictability of the person's needs
Our support process
Initial enquiry and triage
Tell us the meeting date, the records available and who is coordinating the assessment. We confirm whether we can support the timetable before you book.
Scope and fee
We confirm the scope, total fee including VAT, payment stages and any additional costs in writing before you instruct us. Further work is agreed before it starts.
Evidence preparation
We review the relevant records and prepare evidence against the twelve DST domains and the four characteristics of need.
Attendance at the MDT meeting
Your practitioner presents the agreed evidence, helps explain the person's experience and asks for material differences to be recorded.
After the decision
We explain the meeting outcome and the written decision when available. If funding is refused, we identify the relevant review route and deadline.
What we look at
We build the evidence domain by domain before the meeting takes place.
The care records
Daily notes, charts and incident records across a representative period.
The needs assessment and care plan
The independent account of what the person needs.
Clinical input
GP, community nursing, SALT, tissue viability and specialist letters.
Medication and interventions
What is given, when, by whom, and what happens when it is refused.
Night-time and fluctuating needs
The parts of the picture the daytime record misses.
The draft DST
Where the proposed DST scoring departs from the evidence.
What you receive
Support is practical and evidence led. You receive:
A plain English explanation of the DST and MDT meeting process
A domain-by-domain summary of the person's evidence of need
A briefing before the meeting on what to expect and what will be asked
Written representations for the DST meeting
Attendance and representation at the MDT meeting where the DST is completed
A written summary of the MDT meeting and the next steps
Two prices, depending on whether we already have your case
The new client price includes our independent assessment and care plan. The existing case price applies only where we hold a suitable assessment for the same person and continuing case.
Already working with us
- Full care records review
- Evidence prepared domain by domain across the twelve care domains
- Written representations for the assessment meeting
- Attendance and representation at the MDT or DST meeting
- A written summary of the meeting and the next steps
£4,500 including VAT
New to Nellie Supports
- The independent social care needs assessment and care plan included in the package
- Assessment evidence carried forward, with updates for the same continuing case included
- The meeting preparation and representation listed for eligible existing cases
£5,820 including VAT
Fees
£4,500 including VAT
£5,820 including VAT for new clients; £4,500 including VAT for eligible existing cases. Your written scope confirms the assessment, evidence work and meeting attendance included, together with any additional costs.
Fee confirmed in writing
The total fee including VAT, scope and any additional attendance costs are agreed before instruction.
Records review
The relevant records reviewed against the needs and period being assessed.
Evidence mapped to the twelve DST domains
Needs are explained against the DST descriptors and the total care picture.
Representation at the MDT meeting
Your practitioner attends the DST meeting and presents the evidence.
Evidence and reasons explained
The written work identifies the records used, the reasons for our view and any gaps that could affect it.
Clear next steps
A written explanation of the decision and what can follow it.
How DST and MDT meeting support works in practice
A family is preparing for a DST meeting and worries that a brief daytime conversation will miss night-time care and swallowing risks.
In this example, we would review the relevant care and clinical records, prepare the evidence and help explain the needs at the meeting.
The multidisciplinary team would make its recommendation and the ICB would decide eligibility.
The benefit would be an organised account of care, with the evidence and any disagreements clearly recorded for the decision-maker.
Illustrative example only. This does not describe a client or predict an NHS or Ombudsman decision.
For solicitors, deputies, care providers and advisers
We agree a clear instruction and reporting arrangements before starting work.
Scope confirmed in writing
The stage, the fee and the timescale are confirmed in writing before instruction.
Evidence in the language of the framework
Needs are described against the twelve care domains and the four key characteristics, not in general terms.
Evidence and reasons explained
The written work identifies the records used, the reasons for our view and any gaps that could affect it.
A reasoned next step
We explain where the evidence does not support further work and what other route may be relevant.
Why choose Nellie Supports for DST and MDT meeting support
Independent social work support to connect the care records, everyday experience and the questions the assessment must address.
For families
You have someone to explain the process, organise the relevant evidence and help you put the person's needs into words. The work and fee are agreed before we start.
For professionals
We agree the instruction, authority to act, evidence required, reporting arrangements and timetable with you. Written work links each point to its source.
Why families and professionals choose Nellie Supports
Independent social work support
Our social work approach connects the person's everyday needs with the evidence and questions relevant to the CHC stage.
Evidence in the language of the DST domains
The evidence explains both the individual domains and how the person's needs interact.
Fees including VAT
Your scope and total fee including VAT are confirmed before instruction. Additional work is agreed before it starts.
A clear point of contact
A named contact helps you understand the agreed work, the information needed and the next step.
Written work you can follow
The written work identifies the records used, the reasons for our view and any gaps that could affect it.
Honest about outcomes
Eligibility is the Integrated Care Board's decision. We never promise a result, and we say so plainly.
Frequently Asked Questions About the DST and MDT Meeting
Does a positive Checklist mean funding is awarded?
No. A positive Checklist leads to full assessment. The multidisciplinary team then considers the person's total needs and makes a recommendation for the ICB's eligibility decision.
Can you guarantee the person will be found eligible?
No. The NHS decides eligibility. We help prepare and present relevant evidence and explain the strengths, uncertainties and next steps.
Do you attend the MDT meeting in person or remotely?
Attendance can be remote or in person, depending on the NHS meeting arrangements and the agreed instruction. We confirm the format and any attendance costs before booking.
What does the fee include?
Your quote confirms the assessment, preparation, representations and meeting support included. Work beyond that scope is agreed before it starts.
Is this legal advice?
No. Nellie Supports provides independent social work assessment, evidence and advocacy support in England. We do not provide regulated legal advice. We explain when a solicitor's advice is needed.
Related NHS Continuing Healthcare guides
The NHS Continuing Healthcare process explained
A plain English guide to the Checklist, the Decision Support Tool, the MDT and the ICB decision.
The CHC Checklist explained
What the screening tool is, what happens at the meeting and what a positive result actually means.
The Decision Support Tool and the 12 care domains
How the DST scores needs and why the domain language matters.
Who decides CHC eligibility
Who makes the CHC eligibility decision, and on what evidence.
Other CHC support stages
If your situation is at a different stage, our team supports the full NHS Continuing Healthcare pathway.
CHC Appeal Support: Local Resolution
Written submission and representation at local resolution with the Integrated Care Board, the first stage of a CHC appeal. The Independent Review Panel is a separate service.
Retrospective CHC Claims
Review and claim for periods of care that were never assessed, never a percentage.
Nellie Supports provides independent social work assessment, evidence and advocacy support in England. We do not provide regulated legal advice. We explain when a solicitor's advice is needed.
A DST or MDT meeting is coming up?
Contact Nellie Supports to discuss support for the Decision Support Tool (DST) and the multi-disciplinary team (MDT) meeting. We will confirm the right level of support, the fee and the next steps in writing.
Tell us about any urgent date at first contact so we can confirm whether the required timetable can be met.
The twelve care domains the Decision Support Tool scores
The primary health need test
How the DST informs the recommendation
For more, read our guide: The Decision Support Tool and the 12 care domains
£4,500 including VAT
The agreed scope and total fee including VAT are confirmed before work begins. We take no percentage of any funding or repayment. Additional work is agreed separately.
£5,820 including VAT
The independent assessment records relevant needs and provides evidence for the continuing case. Updates for the same person and case are included; reconstructing a different historical period is separately agreed.
Support for previously unassessed periods, starting with a £594 including VAT qualification review including VAT, credited against the full service if you proceed.
Evidence and support for care package reviews, with routine review and eligibility reassessment clearly distinguished.
A DST or MDT meeting is coming up?
Practice leadership: Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.
Our approach to CHC Checklist Request Advocacy Letters
The Nellie Standard is our own framework for clear, evidence-led assessment and advocacy.
For CHC Checklist Request Advocacy Letter, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers whether the available evidence justifies a Checklist request, how needs should be summarised, and how concerns should be presented clearly to the relevant body. The written scope identifies the records and analysis included.
Our written conclusions explain the evidence, reasoning and limits of the position advanced. The NHS or relevant review body makes its own decision.
Evidence before opinion. Correct framework first. Advocacy. Transparent reasoning. Clear conclusions.
Our approach to DST Attendance and Representation
For CHC DST Attendance Representation, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers preparation for the DST meeting, presentation of evidence, domain analysis, professional challenge and clear representation of the person’s needs. The written scope identifies the records and analysis included.
Evidence before opinion. Correct framework first. DST analysis. Supportive process. Transparent reasoning. Capable of scrutiny.
Our approach to DST Viability Reviews
For Decision Support Tool Viability Review, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers whether the available evidence supports a viable challenge, including DST domain evidence, rationale, records, omissions and procedural concerns. The written scope identifies the records and analysis included.
Evidence before opinion. Correct framework first. DST analysis. Transparent reasoning. Clear conclusions. Capable of scrutiny.
Participation and communication in CHC Checklist Request Advocacy Letters
You should be able to describe the care picture and your concerns in your own words. We explain what information is relevant and why.
We support the person's participation and communication, presume capacity and check any authority to act. Capacity concerns are decision-specific; the CHC eligibility question remains separate.
For CHC Checklist Request Advocacy Letters, we agree suitable participation arrangements and explain the process in manageable steps.
The conversation helps explain the relevant needs and interventions. Analysis remains grounded in the National Framework and the evidence for the period being considered.
Your documents organise the relevant evidence, explain significant gaps and set out the recommended next steps.
You can ask us to explain the written reasoning and anything you do not understand.
Participation and communication in DST Attendance and Representation
For DST Attendance and Representation, we agree suitable participation arrangements and explain the process in manageable steps.
Participation and communication in DST Viability Reviews
For DST Viability Reviews, we agree suitable participation arrangements and explain the process in manageable steps.
In this context, the work should help families and professionals understand how needs are evidenced within the DST domains and how records support or challenge the scoring rationale. The conversation should draw out relevant needs, risks, records, family context and practical concerns without turning the process into a rigid checklist.
Your documents organise the relevant evidence, explain significant gaps and set out the recommended next steps.