What is a DST? (Decision Support Tool)

The decision support tool, commonly known as the ‘DST’, is a document that must be completed during a full assessment for NHS continuing healthcare.

The document helps record evidence of a person’s health and care needs to determine eligibility for NHS continuing healthcare funding.

Decision Support tool Checklist

The first step of the process is a form called a “checklist”. It is completed to help determine whether it is appropriate for a person to have a full NHS continuing healthcare assessment.  The threshold for the checklist is set relatively low. If the checklist concludes that a person should have a full assessment carried out, the Integrated Care Board will be contacted.

Who carries out the Decision Support Tool assessment?

The full assessment is carried out by a multi-disciplinary team which should comprise of two or more health or social care professionals who are familiar with the person’s needs. If specialists are involved in a person’s care, these should also be contacted to build a full picture of a person’s needs. 

A family member will also be invited to attend, and they are able to bring along someone to represent them. Our team are regularly contacted by families to attend the decision support tool meeting. Click here to view the Decision Support Tool document.

What happens at the Decision Support Tool assessment?

The decision support tool is the full assessment which is used to examine whether a person’s needs are primarily healthcare needs and are likely to be eligible for NHS continuing healthcare funding. 

Assessors organise and record the evidence about the person’s individual care needs into 12 ‘domains’.  

These are:

  • Behaviour (e.g. aggression or lack of inhibition)
  • Cognition (e.g. confusion, long or short-term memory loss)
  • Psychological and emotional needs (e.g. hallucinations, depression or anxiety)
  • Communication (e.g. are they physically able to talk? Visual aids, body language)
  • Mobility (e.g. risk of falls, inability to bear their own weight)
  • Nutrition – food and drink (e.g. difficulty swallowing)
  • Continence – continent or incontinent – urinary tract infections/catheter
  • Skin and tissue viability (e.g. pressure sores)
  • Breathing (e.g. emphysema or chest infection)
  • Drug therapies and medication – (e.g. Side effects, refusal, pain)
  • Altered states of consciousness (e.g. coma, strokes or fits)
  • Other significant care needs – This domain looks at any other needs that do not fit into any of the domains above (e.g. a person suffering from cancer or significant sleeping difficulties)

The Decision Support Tool assesses the level of need required within the domains listed above. There are six levels of need:

  • No needs
  • Low 
  • Moderate
  • High
  • Severe
  • Priority

Consideration is then given to the nature, intensity, complexity and unpredictability of a need.

The multi-disciplinary team will allocate a level of need to each care domain to determine if the individual has a ‘primary health need’ and then make a recommendation to the Integrated Care Board (ICB) as to whether the person should be entitled to NHS continuing healthcare funding.

Are you prepared for your DST?

We understand that the continuing healthcare process can seem daunting, overwhelming and complex. Still, we cannot stress enough how important it is to be well prepared for your continuing healthcare full assessment.  Click here for our top tips on how to prepare!

How can Moore & Tibbits help?

At Moore & Tibbits, our team has specialist lawyers with years of in-depth knowledge of NHS continuing healthcare and all issues relating to paying for care.  We also have a nurse who is our clinical advisor, Judy Timson RGN, whose expertise ensures we are able to understand the complexities of each case.

We help clients with the following:

  • The assessment process
  • Eligibility for continuing healthcare
  • Appeals of decisions
  • Challenges
  • Annual Reviews
  • Retrospective Applications

For a free initial telephone discussion, please telephone Judy Timson at 01926 354704.

Preparing for a DST assessment


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