The Decision Support Tool assessment: what to expect

The 12 care domains

Each domain is scored from no needs up to priority or severe, depending on the domain. Scores are evidence, not arithmetic — the recommendation must consider the whole picture.

England and Wales each use their own Decision Support Tool. The domain set and the four key indicators are essentially the same, so preparation that works in one country works in the other.

• Behaviour; Cognition; Psychological and emotional needs
• Communication; Mobility; Nutrition
• Continence; Skin integrity; Breathing
• Drug therapies and symptom control; Altered states of consciousness; Other significant needs

The four key indicators

The decision turns on nature, intensity, complexity and unpredictability. In plain terms: what kind of needs are they, how much support do they require, how do the needs interact, and how likely is it that things change without warning?

Unpredictability is frequently under-recorded. Evidence of unplanned interventions, deterioration, refusals and emergency calls is often what shifts a domain score.

Your role in the meeting

You are entitled to be involved, to see the draft DST, and to have your comments recorded — including where you disagree with a domain score. Ask for the evidence behind each score to be stated, and for your evidence to be attached to the document.

• Ask for the meeting date with enough notice to prepare
• Ask for a copy of the draft DST before or at the meeting
• Ask that disagreements are recorded in the document, not just noted verbally
• Bring a second person to take notes

After the assessment

The MDT makes a recommendation; the ICB (England) or Local Health Board (Wales) makes the decision — in England normally within 28 days of the Checklist. You should receive the decision in writing with reasons and a copy of the completed DST. If the outcome is not eligible, the letter should explain how to request a review.