Navigating the complexities of long-term healthcare for loved ones can be overwhelming, especially when considering the financial aspects. For individuals in the UK with significant long-term health needs, NHS Continuing Healthcare (NHS CHC) offers a route to fully funded care. A crucial component in determining eligibility for NHS CHC is the Continuing Care Funding Decision Support Tool. This comprehensive guide will explain what this tool is, how it works, and why it’s essential in the NHS CHC assessment process.
What is the NHS Continuing Care Funding Decision Support Tool?
The NHS Continuing Healthcare Decision Support Tool (DST) is a standardized framework used by multidisciplinary teams (MDTs) to assess whether an individual is eligible for NHS CHC. This funding is provided for adults with complex, intense, and unpredictable healthcare needs that are primarily health-related and require ongoing care beyond what social services typically provide. The DST is not a diagnostic tool, nor does it determine specific care packages. Instead, it is a structured process to evaluate the nature and intensity of an individual’s care needs to ascertain if they qualify for NHS CHC funding.
The DST ensures consistency and fairness in the assessment process across different Integrated Care Boards (ICBs) in the UK. It helps MDTs to systematically consider all relevant aspects of an individual’s health needs, moving away from solely relying on diagnoses and focusing instead on the level and type of care required.
How Does the Decision Support Tool Work?
The Decision Support Tool is applied during the full assessment for NHS Continuing Healthcare. This full assessment is triggered after an initial checklist indicates that an individual may be eligible. The DST assessment is conducted by a Multidisciplinary Team (MDT), which includes at least two professionals from different healthcare disciplines, often involving both health and social care professionals already familiar with the individual’s needs.
The DST assessment process involves evaluating needs across twelve specific care domains:
- Breathing: Assessment of respiratory needs and support.
- Nutrition (Food and Drink): Evaluation of feeding requirements, including assisted feeding or special diets.
- Continence: Assessment of bladder and bowel management needs.
- Skin (Including Wounds and Ulcers): Evaluation of skin integrity and the need for wound care or pressure ulcer prevention.
- Mobility: Assessment of physical movement abilities and assistance required.
- Communication: Evaluation of communication abilities and support needs.
- Psychological and Emotional Needs: Assessment of mental health and emotional well-being support needs.
- Cognition (Understanding): Evaluation of cognitive function and support for memory or understanding difficulties.
- Behaviour: Assessment of behavioral patterns and management strategies required.
- Drug Therapies and Medication: Evaluation of medication management needs and complexity.
- Altered States of Consciousness: Assessment of awareness levels and needs arising from altered consciousness.
- Other Significant Care Needs: Consideration of any other substantial healthcare needs not covered in the previous categories.
For each of these domains, the MDT will assign a level of need based on provided evidence and professional judgement. The levels range from “no needs” to “low,” “moderate,” “high,” “severe,” and “priority.” These levels are clearly defined within the Decision Support Tool, ensuring a consistent approach across all assessments.
Eligibility Thresholds and the DST
The Decision Support Tool provides guidelines for eligibility based on the assessed needs levels. While each case is considered holistically, certain thresholds generally indicate eligibility for NHS CHC.
Typically, an individual is likely to be eligible if they have:
- At least one priority need in any domain, OR
- Severe needs in at least two domains.
Eligibility can also be considered if an individual has:
- A severe need in one domain plus several other needs, OR
- Multiple high or moderate needs, depending on their combined impact, complexity, intensity, and unpredictability.
It’s crucial to understand that the DST is not a points-based system. The MDT must consider the overall picture of an individual’s needs, including the interaction and cumulative effect of multiple needs, and the risks associated with unmet needs. The decision must be evidence-based and clearly documented, explaining how the DST was applied and why the eligibility decision was reached.
Your Role in the Decision Support Tool Process
Individuals being assessed for NHS CHC, along with their families and carers, should be actively involved in the DST assessment process. Your insights and perspectives are vital for the MDT to gain a complete understanding of the individual’s needs. You have the right to:
- Be informed about the assessment process and the use of the Decision Support Tool.
- Provide information and evidence about the individual’s care needs.
- Express your views and have them taken into account by the MDT.
- Receive a copy of the completed Decision Support Tool and the eligibility decision, along with clear reasons for the outcome.
If you disagree with the eligibility decision, you have the right to request a review or appeal through the ICB. Understanding the Decision Support Tool and its role empowers you to participate effectively in the assessment process and advocate for the care your loved one needs.
Accessing the Decision Support Tool
The NHS Continuing Healthcare Decision Support Tool is a publicly available document, designed to ensure transparency in the assessment process. You can download a blank copy of the tool from the GOV.UK website. Familiarizing yourself with the domains and the levels of need outlined in the DST can help you better understand the criteria used in NHS CHC assessments and prepare for discussions with the MDT.
Download the Decision Support Tool for NHS Continuing Healthcare from GOV.UK (PDF, 194KB)
Conclusion: The DST as a Key to Continuing Care Funding
The continuing care funding decision support tool is a cornerstone of the NHS Continuing Healthcare assessment process. It provides a structured and standardized method for evaluating complex health needs and determining eligibility for fully funded NHS CHC. By understanding how the DST works, individuals and their families can better navigate the assessment process, ensure their voices are heard, and work towards securing the necessary funding for long-term care. For further support and independent advice, organizations like Beacon CHC offer valuable resources and helplines to guide you through every step of the NHS Continuing Healthcare journey.
