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Decision Support Tool (DST)
This assessment is more thorough than the Continuing Healthcare Checklist. Again, this assessment is largely a medical review of need, and will look at medical evidence available. This may be care setting notes, hospital & GP notes, reports from professionals involved in care such as a Psychiatrist or Speech and Language Therapist etc. You can find a copy of the decision Support Tool here.
How is the DST Assessment Done?
There will be a ‘Multi-Disciplinary Team’ (MDT) made up of a Social Worker (from your Local Authority) and a Nurse Assessor (from your Local Clinical Commissioning Group). The Multi-disciplinary team can also be made up of 2 nurses, from different parts of the register (e.g a Mental Health Nurse (RMN) and a General Nurse (RGN). They will lead the DST and make the overall decision between themselves regarding funding.
You should always have the opportunity to attend the DST yourself, and it is good practice for the MDT to have sight of the patient before the DST begins.
A relative or representative should be there to represent the Applicant at the assessment if the Applicant is unable to partake in the assessment themselves, which is extremely common. If you have a care service that looks after the Applicant, whether it’s supported living or a care agency at home, a carer/manager that knows the Applicant well should be present too.
This DST will look at the 12 domains (the 11 from the Checklist in more detail and ‘12 – Other’. This domain is for any health needs you have that don’t fit into the other 11 domains). The panel should go through all medical evidence that is available. The panel should have access to the Applicant’s records, but we feel it is a good idea to bring copies of any medical evidence you have that you feel will be useful. Prior to any DST, we will seek copies of all evidence and review the same thoroughly to ensure Domain scoring is appropriately recorded.
The MDT will look at each domain in more detail to see how the Applicant’s health needs effect their daily life and what care needs arise from this. They will look at the level of care you are currently getting and the level of care that their health needs may require.
The MDT is looking to see if the Applicant has a Primary Health Need. A Primary Health Need is NOT a medical condition but they may arise out of a diagnosed condition. To put it simply, having a Primary Health Need means that evidenced needs are above and beyond what ‘universal services’ cover and over what they will pay for. It usually means the Applicant’s care should be delivered by a trained Nurse or at least require nursing oversight.
Once all of the domains have been discussed, the MDT will meet on their own (usually a continuation of the DST meeting immediately following discussions) and decide whether or not you are eligible for funding.
The National Framework for Continuing Health Care and NHS Funded Nursing Care (which contains all the rules that govern the Assessment process) page 46 , paragraph 162 states:
‘It is expected that CCGs will normally respond to MDT recommendations within 48 hours (two working days), and that the overall assessment and eligibility decisionmaking process should, in most cases, not exceed 28 calendar days from the date that the CCG receives the positive Checklist (or, where a Checklist is not used, other notice of potential eligibility) to the eligibility decision being made.’
How Long Does the Process Take?
Funding routes following the DST:
Full funding – If you are found to have a Primary Health Need, the NHS will fund all of your care – there is no provision to charge ‘top up’ fees if funding is awarded.
Funded Nursing Care – If you are found not to have a Primary Health Need, but are found to have needs the require nursing oversight, the NHS will contribute a small sum (currently £187.00 per week) towards this aspect of your care.
Not eligible – if you are found not to have a primary health need or needs that require nursing oversight, the NHS will not fund your care, and it will be down to you to fund. Your local authority will help you fund your care if you have under £23,250.00 in cash and assets.
You are entitled to appeal the decision from the CCG
If you do not accept the decision, give us a call for a no obligation discussion as to whether the decision is worth appealing - 01536 516 251.