CHC, put simply.
What is a DST?
DST stands for:
Decision Support Tool
A DST is not a test.
It is not a pass or fail exam.
It is not simply adding up scores.
It is a structured meeting where professionals and family members discuss a person's needs and consider whether they have a Primary Health Need.
How the DST works
The Meeting
Decision Support Tool
DST
N
Nature
I
Intensity
C
Complexity
U
Unpredictability
The Question
Primary Health Need?
✓ Eligible
NHS Responsible
Not Eligible
Local Authority
Who attends the DST?
The purpose of the meeting is to gather all relevant information and build a complete picture of the person's needs.
NHS Assessor
Social Worker
Nurses & Healthcare Professionals
Care Home Staff
Therapists
The Individual
Family Members
The DST Meeting Table
Families should be involved and given the opportunity to share their views.
What does the DST look at?
The DST is divided into different care areas called domains.
Behaviour
Cognition
Psychological & Emotional Needs
Communication
Mobility
Nutrition
Continence
Skin
Breathing
Drug Therapies & Medication
Altered States of Consciousness
Other Significant Care Needs
Each domain helps professionals understand the nature and severity of a person's needs.
There is NO pass mark.
Many families believe:
"You need a Priority."
"You need two Severes."
This is not how CHC decisions are made.
The National Framework explains:
- Certain scores may indicate eligibility.
- But there is NO automatic eligibility.
- Every person must be considered individually.
The most important part of the DST
The DST does not decide eligibility by itself.
The real purpose of the DST is to answer one question:
Does this person have a Primary Health Need?
Nature
What are the needs?
Intensity
How much support is needed?
Complexity
How do the needs interact?
Unpredictability
How quickly can things change?
The Answer
Primary Health Need
The whole picture matters
The decision should never be based on:
- A diagnosis alone
- A single domain score
- Whether care is being managed well
- Whether someone lives at home or in a care home
Instead:
Professionals should consider the totality of the person's needs and use their professional judgement to determine whether they have a Primary Health Need.
Remember
The Decision Support Tool is exactly what its name says:
A tool to support decision making.
The most important decision is:
Who is responsible for meeting these needs?
That answer is called:
A Primary Health Need.
And that is what determines NHS Continuing Healthcare eligibility.