NHS Continuing Healthcare
CHC Assessment Support: Decision Support Tool (DST) and MDT Meeting Representation
CHC assessment support helps a family prepare for the NHS Continuing Healthcare Decision Support Tool (DST), the full assessment completed at a multi-disciplinary team (MDT) meeting. A registered professional explains the DST process, prepares the evidence of need across the twelve care domains, and attends the MDT meeting to present that evidence, so the person's needs are recorded accurately and the Integrated Care Board's eligibility decision is made on complete information. The fee is £3,750 plus VAT for returning clients and £4,850 plus VAT for new clients, with travel charged separately.
Evidence prepared for the Decision Support Tool and representation at the multi-disciplinary team (MDT) meeting, across England
At a glance
Role
Preparation for, and representation at, the Decision Support Tool (DST) assessment and MDT meeting
Framework
National Framework for NHS CHC and NHS-funded Nursing Care, 2022 revision
Format
Evidence preparation, then attendance at the multi-disciplinary team (MDT) meeting where the DST is completed
Deliverable
Evidence prepared domain by domain, and representation at the MDT meeting
Coverage
England. Wales runs its own Continuing NHS Healthcare framework
£3,750
Fixed fee, plus VAT
One working day
Response to your enquiry
England
Cover throughout the country
Social work led
Registered professionals
Plain-English explanation
What DST and MDT meeting support is
Preparation and representation for the Decision Support Tool (DST), the full assessment where a multi-disciplinary team (MDT) scores the person’s needs across twelve care domains.
The Decision Support Tool (DST) is the full assessment. A multi-disciplinary team (MDT) meets to score the person’s needs across twelve care domains and makes a recommendation to the Integrated Care Board.
We prepare the evidence before the MDT meeting, attend it with you, and make sure each DST domain is scored against what the records and the day-to-day reality actually show.
A good day is not the whole picture
Domains scored on a settled morning understate need. The question is what the person requires across a typical week, including the nights, the refusals and the interventions nobody has written down.
Common situations
When you need DST and MDT meeting support
A Checklist is a screening tool completed by a health or social care professional to decide whether a full assessment is needed. A positive Checklist does not award funding; it triggers the full assessment, where a multi-disciplinary team (MDT) meets to score the person's needs across the twelve care domains of the Decision Support Tool (DST).
Families are often given little notice of the MDT meeting and no guidance on what evidence matters. Support at this stage means the person's day-to-day needs are described accurately, in the language of the DST domains, before the Integrated Care Board makes its eligibility decision.
A DST or MDT meeting has been booked
You have a date and want the evidence ready before it.
You are attending alone
Nobody at the MDT meeting is there to speak for the person’s needs.
The Checklist was positive
The full DST assessment follows, and it is the stage that decides funding.
The care record is thin
What the person needs has never been written down properly.
Needs fluctuate
Domains scored on a good day do not reflect the risk.
A previous DST went badly
You are being reassessed at a new MDT meeting and want it done differently this time.
What is assessed
The twelve care domains the Decision Support Tool scores
The multi-disciplinary team (MDT) scores each domain from no needs up to priority, and those levels inform the recommendation to the Integrated Care Board. One priority, or two or more severe, usually indicates a primary health need, though the scores never decide the outcome on their own. This is the language your evidence has to be in.
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
A primary health need is a reasoned judgement about the nature, intensity, complexity and unpredictability of the needs taken as a whole. A decision that reads as arithmetic, with no reasoning recorded, is a decision worth questioning.
1
The primary health need test
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.
Nature of the person's needs
Intensity of the person's needs
Complexity of the person's needs
Unpredictability of the person's needs
2
How the judgement is made
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
For more, read our guide: The Decision Support Tool and the 12 care domains
The framework
The framework the assessment applies
Initial enquiry and triage
Contact us by phone, email or website form. We gather the key details and confirm whether assessment support is the right route within one working day.
Scope and fee
We confirm the scope, the fee plus VAT and any travel charge, in writing before you commit to anything.
Evidence preparation
A registered professional reviews the care records and prepares the evidence of need against the twelve care domains of the Decision Support Tool (DST).
Attendance at the MDT meeting
Your practitioner attends the multi-disciplinary team (MDT) meeting at which the DST is completed, presents the evidence domain by domain and deals with the questions the family would otherwise be asked cold.
After the decision
We explain the written decision and, where the outcome is not eligible, the challenge options and the six month timescale.
What happens next
Our support process
Evidence base
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.
Deliverable
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
Who we work with
For solicitors, deputies, care providers and advisers
Instruction is straightforward and the evidential standard is consistent whichever stage we are brought in at:
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.
Peer review as standard
A second qualified professional reviews the work before it is submitted.
Honest merits advice
Where a case has no realistic prospect, we say so before you spend anything further on it.
Already working with us
£3,750 plus VAT
- 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
One fee, agreed in writing before any work starts, and never a percentage of what is recovered. Most CHC support is charged by the hour or as a share of the outcome, so the cost is unknown when you commit and grows the longer the case runs. Ours is stated up front, plus VAT and travel, and does not change if the case turns out to be harder than expected.
New to Nellie Supports
£4,850 plus VAT
- The Independent Social Care Needs Assessment and Care Plan, £1,100 plus VAT
- Charged once per client and never re-charged as your case progresses
- Everything listed in the returning price
The needs assessment is not an administrative step, and it is the reason our later stages cost less than they otherwise would. It is an independent professional record of what the person actually needs, written in the language the twelve care domains are scored in, before the NHS process forms its own view. Every stage after it builds on that record rather than starting again, which is why it is charged once and never re-charged.
Transparent pricing
Two prices, depending on whether we already have your case
The work is identical. What differs is whether the gateway assessment has already been done and paid for. It is charged once per client and never re-charged, so every later stage of your case is at the returning price.
For families
A clear fee, agreed in writing before we start, with no percentage of anything recovered. We explain what is happening in plain English and deal with the process so you do not have to.
For professionals
Scope, fee and timescale confirmed in writing before instruction. Evidence prepared against the twelve care domains and the four key characteristics, peer reviewed by a second qualified professional.
Provider evidence
Why choose Nellie Supports for DST and MDT meeting support
Registered professionals who know how the twelve DST domains are scored, sitting on your side of the table at the MDT meeting.
Why families and professionals choose Nellie Supports
Social work led, not a claims company
Registered professionals prepare and present the evidence of need. We are not a call centre and not a no-win-no-fee operation.
Evidence in the language of the DST domains
Needs are described the way the Decision Support Tool scores them, so nothing important is lost in translation.
Published fees, plus VAT
The whole price is published and confirmed in writing before instruction. No percentages, no surprises.
A permanent employed team
A full-time, in-house multidisciplinary team, not an ad hoc panel of associates, with more than 11,000 assessments completed practice-wide.
Peer reviewed as standard
Everything we prepare is reviewed by a second qualified professional before it is used.
Honest about outcomes
Eligibility is the Integrated Care Board's decision. We never promise a result, and we say so plainly.
A daughter had five days' notice of her father's Decision Support Tool meeting. He had advanced Parkinson's, and on his best days he could hold a conversation and manage a cup of tea. She was terrified the meeting would see that man and miss the one who choked on his food twice a week and could not be left for twenty minutes.
A registered professional read the care records and mapped what was actually written there to the twelve care domains: the choking risk, the night-time supervision, the medication timed to the quarter hour. On the day, the practitioner sat beside her and presented that evidence domain by domain, so the multidisciplinary team assessed the whole picture rather than a good morning.
The eligibility decision was the Integrated Care Board's to make. What changed was that it was made on the complete evidence.
The multidisciplinary team scores the domains, and it does so largely on the evidence the assessing clinician brings. A family with no independent assessment of their own is arguing about someone else’s account of their relative. Because we assess and write our own, the meeting had two professional records in front of it rather than one, and the difference between them had to be reasoned through rather than assumed away.
This is an illustrative example. It does not describe any individual client.
How DST and MDT meeting support works in practice
Frequently asked questions
Frequently Asked Questions About the DST and MDT Meeting
Does a positive Checklist mean funding is awarded?
No. The Checklist is a screening tool, not a decision. A positive Checklist triggers the full assessment, where a multi-disciplinary team (MDT) scores the person's needs across the twelve care domains using the Decision Support Tool (DST). The Integrated Care Board then makes the eligibility decision based on whether the evidence shows a primary health need. The Checklist therefore opens the door to assessment; it does not itself award funding.
Can you guarantee the person will be found eligible?
No, and no honest provider can. Eligibility depends on whether the person's overall needs amount to a primary health need, judged on the evidence by the multi-disciplinary team (MDT) and the Integrated Care Board. Our job is to make sure that evidence is complete, accurate and properly presented, so the decision is made on the strongest possible picture of the person's needs.
Do you attend the MDT meeting in person or remotely?
Either, depending on what the meeting arrangements allow and what suits the person and family. Many Checklist and DST meetings now run remotely or in hybrid form, and we attend in whichever format the Integrated Care Board offers. Travel for in-person attendance is confirmed in writing before booking, so there are no surprises on cost.
What does the fee include?
The published fee covers all the work described on this page, plus VAT, from preparation of the evidence through to the MDT meeting itself. Travel for in-person attendance is the only possible addition, and it is confirmed in writing before you book, so the total cost is known before any work begins. There are no hidden extras.
Is this legal advice?
No. 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. In assessment support this means we prepare evidence and represent the person's needs at the meeting, while legal questions remain matters for a solicitor.
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.
Supporting guidance
Related NHS Continuing Healthcare guides
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
Claims for periods of care that were never assessed, starting with a £495 records review credited if you proceed. Never a percentage.
CHC Review Support
Independent evidence for the 3 month and annual reviews of a care package, where a reassessment can reduce or withdraw funding.
Other CHC support stages
Discuss your case
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.
Written by Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.