Reaching the Decision Support Tool (DST) stage of the NHS Continuing Healthcare (CHC) process is a significant milestone. If your relative has progressed beyond the Checklist, it means there is sufficient evidence to warrant a full assessment of their healthcare needs.

For many families, however, the DST meeting is daunting. Medical professionals, unfamiliar terminology, and a lengthy assessment document can make it feel overwhelming.

The good news is that you do not need to be a lawyer or healthcare professional to contribute meaningfully. With the right preparation and an understanding of how the process works, you can ensure your loved one’s needs are accurately represented.

This guide explains how to approach a DST assessment with confidence.

What Is the Decision Support Tool?

The Decision Support Tool is a structured assessment document used by the multidisciplinary team (MDT) to determine whether someone has a Primary Health Need, which is the legal test for eligibility for NHS Continuing Healthcare funding.

It is not a scoring sheet or a checklist. Instead, it provides a framework for assessing the nature, intensity, complexity and unpredictability of a person’s needs across twelve care domains.

The MDT uses the completed DST to make a recommendation to the Integrated Care Board (ICB), which usually makes the final eligibility decision.

Understand What Is Being Assessed

One of the biggest misconceptions is that the DST is about diagnoses.

It isn’t.

Having dementia, Parkinson’s disease, multiple sclerosis or another serious condition does not automatically qualify someone for CHC funding.

Instead, assessors are looking at the care required because of those conditions.

For every need identified, ask yourself:

What support is required?
How often is it needed?
Who provides it?
What skills are required?
What would happen if that support wasn’t available?

Those are the questions that help demonstrate healthcare needs.

Familiarise Yourself with the Twelve Care Domains

The DST considers needs across twelve domains:

Behaviour
Cognition
Psychological and emotional needs
Communication
Mobility
Nutrition
Continence
Skin integrity
Breathing
Drug therapies and medication
Altered states of consciousness
Other significant care needs

Each domain is assigned a level of need based on the available evidence.

Rather than trying to memorise every descriptor, focus on understanding how your loved one’s daily experiences fit within each domain.

Gather Strong Evidence Before the Meeting

Evidence is the foundation of a fair assessment.

The MDT will consider information from a range of sources, including:

Care plans
Daily care records
Hospital discharge summaries
GP records
Therapy assessments
Incident reports
Falls records
Weight charts
Pressure ulcer documentation
Medication records

You should also make your own notes.

Think about examples that demonstrate the person’s needs, particularly where those needs are frequent, unpredictable or require skilled intervention.

Specific examples are far more persuasive than general statements.

Think in Terms of Risks

The DST isn’t just about what happens.

It’s also about what could happen if appropriate care isn’t provided.

Consider questions such as:

Is there a risk of falls?
Could medication be missed?
Is there a risk of choking?
Are there behavioural risks to themselves or others?
Could skin integrity deteriorate rapidly?
Are there risks associated with wandering or poor decision-making?

Understanding risk helps explain why certain interventions are necessary.

Be Honest About the Reality of Daily Life

Many families unintentionally minimise their loved one’s needs.

It’s natural to want to focus on the positives, but the DST should reflect the person’s usual experience—not their best day.

Describe what typically happens.

If care is needed every day, say so.

If behaviours fluctuate, explain how often and how severe they are.

If support is required to keep someone safe, make that clear.

The assessment should present an accurate picture, not an optimistic one.

Don’t Be Afraid to Contribute

Family members often know the person better than anyone else in the room.

You may notice patterns that professionals haven’t seen.

You may be able to explain why incidents occur.

You may know how needs have changed over time.

If you disagree with something being discussed, explain why calmly and support your view with examples wherever possible.

Your perspective is an important part of the assessment.

Understand the Concept of a Primary Health Need

This is arguably the most important concept in the entire CHC process.

Eligibility is not determined simply by adding together scores across the domains.

Instead, the MDT must consider whether the person’s needs, viewed as a whole, demonstrate a Primary Health Need.

To reach that conclusion, they consider four key characteristics:

Nature

What are the needs, and what type of care is required?

Intensity

How severe are the needs, and how much care is required to manage them?

Complexity

How do different needs interact, making care more difficult to deliver?

Unpredictability

How likely are needs to change suddenly or require rapid intervention?

Understanding these principles will help you see the assessment as more than a collection of individual scores.

Read the Completed DST Carefully

Before the recommendation is finalised, ask for a copy of the completed Decision Support Tool if one is available.

Check that:

Your loved one’s needs have been described accurately.
Important incidents haven’t been omitted.
The rationale reflects the evidence discussed.
The information is factually correct.

If something is inaccurate, raise it promptly.

Small errors can have a significant impact on the overall recommendation.

Remember That the Meeting Is About Evidence, Not Opinions

Strong contributions are based on facts.

Instead of saying:

“I think Mum is much worse than that.”

Try saying:

“Over the last month she has fallen four times despite supervision, required two ambulance call-outs, and now needs two carers for all transfers.”

Evidence gives your comments credibility and helps the MDT understand the true picture.

Preparation Builds Confidence

The families who leave a DST meeting feeling satisfied are not necessarily those who receive funding.

They are the families who know they have accurately represented their loved one’s needs.

Preparation allows you to:

Understand the assessment process.
Recognise what assessors are looking for.
Present relevant evidence.
Correct inaccuracies.
Ask informed questions.
Feel confident contributing throughout the meeting.

Want to Feel Fully Prepared?

Understanding the Decision Support Tool before you attend your assessment can make a significant difference to how confidently you participate.

Our NHS Continuing Healthcare Assessment Guide explains:

Every DST domain in plain English.
What each level of need means.
How assessors apply the National Framework.
The legal test for a Primary Health Need.
How to gather persuasive evidence.
Common pitfalls families encounter.
What happens after the assessment, including appeals.

Whether you’re approaching your first DST meeting or supporting a family member through the process, the guide is designed to help you understand what to expect and how to prepare.

Final Thoughts

The Decision Support Tool is not about saying the “right” things or arguing with professionals. It is about ensuring that your loved one’s needs are fully understood, accurately recorded and assessed against the National Framework.

The more prepared you are, the more effectively you can contribute to that process.

A well-prepared family doesn’t change the rules—but it can help ensure those rules are applied fairly.