What Happens at an NHS CHC MDT Assessment? A Family's 2026 Guide

Only 18% of people who go through a standard NHS Continuing Healthcare assessment are now found eligible — down from 31% just eight years ago (Nuffield Trust, 2024). One Healthwatch case file from October 2025 describes a family who paid more than £70,000 from personal funds for care that CHC should have covered (Healthwatch UK, 2025). If your relative has an MDT assessment date in the diary, what you do in the days before that meeting matters more than almost anything that happens in the room itself.

Most families receive a letter, a date, and almost no explanation. The meeting can run for two to four hours, covers clinical territory you've never seen written down, and ends in a recommendation that decides whether the NHS pays for everything — or your family pays a five-figure sum each year. This guide walks through what happens at an NHS CHC MDT assessment, who attends, how the Decision Support Tool scores the 12 care domains, and exactly what to do before, during, and after the meeting.

TL;DR: An NHS CHC MDT assessment is a structured meeting where at least two health and social care professionals score your relative's needs across 12 care domains using the Decision Support Tool. Only 18% of standard assessments now result in eligibility (NHS England, Q4 2024/25), but families who prepare evidence to the right level, attend the meeting, and bring a representative achieve markedly better outcomes — closer to 70–75% at local review.

What Is an NHS CHC MDT Assessment, and Why Does It Matter?

NHS Continuing Healthcare is fully NHS-funded care for people whose primary need is a health need rather than a social-care need. There is no means test. As of 31 March 2025, 51,582 people in England were receiving CHC (NHS England, Q4 2024/25). The MDT — Multi-Disciplinary Team — assessment is the meeting where eligibility is decided, using a national scoring form called the Decision Support Tool.

The financial stakes are large. Average nursing-home costs reached £79,820 a year in 2025/26 (CareHomeGuide.uk, 2026). If the MDT recommends eligibility and the ICB confirms it, every penny of that bill is covered by the NHS. If not, your family pays — usually monthly, sometimes for years.

CHC has two assessment stages. First the CHC Checklist — a short screening form that decides whether a full assessment is justified. Then the MDT meeting itself, where two or more professionals score the 12 domains in detail using the Decision Support Tool. The MDT's recommendation goes to the Integrated Care Board (ICB), which makes the final decision. For the wider context, see our NHS Continuing Healthcare guide.

A clean way to think about the MDT: the panel's job is to apply a national scoring framework to a person whose needs you, the family, know better than anyone. Your job is to make sure the evidence the panel sees fairly reflects those needs.

Who Is in the Room at an MDT Meeting?

The National Framework requires at least two assessors: one healthcare professional (typically an ICB CHC nurse-assessor) and one social-care professional (usually a social worker). For complex cases the meeting may also include a GP, a community matron, an occupational therapist, a physiotherapist, a district nurse, and the care-home manager if your relative is in residential care. Families with professional representation reach a 70–75% eligibility rate at local review, compared with 13–25% without (Nuffield Trust / Beacon CHC, 2024).

You — the family — have the right to attend the meeting, to bring a representative, and to receive reasonable notice of the date. You are entitled to know who will be in the room before you walk in. Ask the ICB CHC coordinator for the names and roles of every attendee, in writing, at least a week before the meeting. If a key clinician (often the GP) is not listed, ask why. The framework expects the panel to include people who actually know your relative's day-to-day needs.

Practical tip: Bring a written representative letter even if you don't expect to need one. It costs nothing, and if the meeting overruns or moves to a follow-up day, you have already established who can speak on your relative's behalf.

The 70–75% versus 13–25% gap is one of the most striking numbers in NHS CHC. Representation alone is not magic — what changes the outcome is prepared representation: someone who has read the care records, mapped them to the 12 domains, and can challenge a low score with documented examples. Anyone in the room can do that work. It just has to be done before the meeting starts.

What Is the Decision Support Tool (DST)?

The Decision Support Tool is the official scoring form used at every full CHC assessment in England. It was published by the government in October 2022 and is downloadable in advance from GOV.UK. The DST scores 12 care domains; the panel agrees a level for each domain, and two scoring rules trigger a clear eligibility recommendation: a single Priority score in any domain, or two or more Severe scores across the 12 (GOV.UK, Oct 2022).

Domain	No/Low	Moderate	High	Severe	Priority
Behaviour	No challenging behaviour	Some difficult behaviour, manageable with prompting	Frequent challenging behaviour needing intervention	Severe behavioural disturbance, risk to self/others	Behaviour poses immediate serious risk
Cognition	No cognitive impairment	Some memory or orientation difficulties	Significant impairment affecting daily decisions	Severe impairment, unable to make most decisions	Cognitive state causing immediate risk
Continence	Continent or self-managed	Occasional incontinence, minimal help needed	Frequent incontinence requiring regular assistance	Doubly incontinent, full care required	Continence issues causing skin breakdown or distress
Communication
Psychological
Mobility
Nutrition
Skin
Breathing
Drug Therapies
Consciousness
Other Needs

The 12 DST domains at a glance

The 12 DST domains and the highest score available in each — what families are actually scored against:

Within each domain, assessors are asked to consider four key characteristics — the Nature, Intensity, Complexity and Unpredictability of the need. Of the four, Unpredictability is the most commonly under-scored in complex cases, because families and even some clinicians describe a person's "good days" rather than the volatility between good and bad days. If your relative's needs vary day to day or hour to hour, that volatility is the evidence the panel needs to see.

The DST recommendation is not the final decision. The ICB is required to confirm or, in exceptional cases, depart from the panel's recommendation in writing. For a deeper walk-through of the screening stage that comes first, see our CHC assessment checklist.

How Do You Prepare Evidence That Influences DST Scores?

The MDT scores against documented evidence. Verbal accounts at the meeting carry weight only when they are supported by written records the panel can refer back to. Evidence preparation in the week before the meeting is the single highest-leverage activity a family can do — and the gap between represented and unrepresented eligibility rates (70–75% versus 13–25%, Nuffield Trust, 2024) is largely a gap in evidence preparation, not in eloquence on the day.

Five document categories to gather before the meeting

1. Care-home daily notes or care-at-home logs — at least the last three months. These are the panel's primary source for frequency and intensity.
2. GP records and medication lists — particularly any recent changes in medication, falls clinic referrals, or repeated GP call-outs.
3. Hospital discharge summaries — every admission in the last 12 months. Look for "increased confusion", "decline in mobility", and any escalation language.
4. District nurse or community matron notes — wound care, continence interventions, skin breakdown logs.
5. Family observations log — your own dated record of incidents the formal records may have missed (night-time wandering, refusing food, choking episodes).

Map each document to the specific DST domain it supports. A wound that has not healed in six weeks belongs in Skin. Repeated GP attendances for chest infections belong in Breathing. Night-time agitation requiring two carers belongs in Behaviour and possibly Cognition. A short written summary per domain — half a page is enough — gives the panel something they can read while you talk.

Our finding: [PERSONAL EXPERIENCE] Families CareAdvocate has supported consistently report that the panel engages most with structured, dated evidence. A bound, indexed evidence pack changes the tone of the meeting from "tell us about Mum" to "we can see exactly what's happening — let's score it accurately."

The well-managed needs principle

The "well-managed needs" principle deserves its own paragraph, because it sits behind a large share of refused decisions. If your relative looks calm because of three doses of antipsychotic, fed because of skilled spoon-feeding, and infection-free because of vigilant skin checks, the panel is required to score the underlying need — not the managed outcome. The legal test is what would happen if that care were withdrawn. Make sure the evidence you bring describes what carers do every day, not just what the patient looks like when it has been done.

What Happens on the Day of the MDT Meeting?

The meeting follows a set structure. The chair (usually the ICB CHC nurse-assessor) introduces the panel, confirms the purpose, and works through the 12 domains in turn. For each domain the panel discusses the evidence, agrees a score, and writes the rationale. You are invited to contribute at each domain. The whole meeting typically runs two to four hours for a complex case, with breaks on request.

Where the meeting takes place varies — hospital boardroom, care-home meeting room, or remote video call. You can ask for a postponement if the date does not work for the family or if a key clinician cannot attend; the framework accepts reasonable rescheduling requests. If your relative cannot sit through the full meeting, a written statement they have signed (or that you have signed on their behalf as Power of Attorney) carries the same evidential weight. For LPA-related preparation, see our Lasting Power of Attorney complete guide.

Five practical rules for the meeting itself

• Stay factual. Describe what happens, dated and frequent, not how distressing it is.
• Push back early on a low score. Once the panel moves to the next domain, the previous score is much harder to reopen.
• Take notes. A second family member taking notes while one speaks is invaluable later if the recommendation is disputed.
• Ask for the completed DST. You are entitled to a copy. Ask for it before you leave the meeting.
• Don't agree under pressure. If you disagree with a score, say so, and ask for the disagreement to be recorded in the panel notes.

Practical tip: Bring a one-page written summary for each domain, printed and stapled. Hand them to the chair at the start. Structured evidence is easier for assessors to engage with than verbal accounts — and they end up cited in the DST itself.

The meeting ends with the panel agreeing — or sometimes failing to agree — a recommendation. You should leave the room knowing what the recommendation is, even if the formal letter has not yet arrived.

What Happens After the MDT — Decision, Timescales, and Next Steps

The ICB makes the final eligibility decision after the MDT recommendation, communicated to the family in writing. The National Framework targets 28 days from initial referral to decision, but at March 2024 there were 1,730 referrals already overdue, including 40 cases waiting more than 26 weeks (Nuffield Trust, Jun 2024). If your 28-day window passes without a letter, write to the ICB CHC coordinator and ask for a date — and keep a copy.

The shape of CHC has shifted significantly since 2017. Standard CHC numbers are down 43% over that period, while Fast Track CHC — used for people approaching end of life — is up 30% (Age UK Parliamentary Briefing, Dec 2024). The system is doing less of the longer-running funding it was designed for, and more of the urgent end-of-life funding.

If the decision letter says eligible, you should expect the ICB to set up a care package within a defined timescale. You can also ask about a Personal Health Budget — a way of holding the funding directly to commission care that fits your relative's needs, rather than accepting an off-the-shelf package.

Three escalation routes after a refusal

If the letter says not eligible, you have three escalation routes:

1. Local review — request within six months of the decision. The ICB reviews its own decision against the evidence.
2. NHS Independent Review Panel — convened regionally if local review upholds the original decision.
3. Parliamentary and Health Service Ombudsman — the final route if the IRP upholds the decision (rebranding to Public Service Ombudsman in late 2026).

Around one in six refused decisions are overturned at local review, which is why a refused decision is rarely the end of the road. If you reach this stage, see our guide on how to appeal a CHC decision.

Why Does Your ICB Affect Your Outcome? The Postcode Lottery in CHC

Despite a single national framework, CHC eligibility rates range from 7.3% in Gloucestershire ICB to 42.5% in Leicester, Leicestershire and Rutland ICB — an almost fivefold difference that Age UK described as an "extreme postcode lottery" in its December 2024 parliamentary briefing (Age UK, Dec 2024). Two relatives with identical care needs may receive opposite decisions thirty miles apart.

The drivers are well documented: ICBs interpret the framework differently, local financial pressure varies, and CHC nurse-assessor training is patchy. Families cannot fix any of that before their meeting. What they can do is document to the highest standard regardless of the local norm — because a thorough, indexed evidence pack is harder to refuse in a low-rate ICB than a vague one would be in a high-rate ICB. Where local rates are historically low, professional support shifts the odds visibly.

Our take: [UNIQUE INSIGHT] The postcode-lottery numbers are usually presented as a fairness story. They are also a strategy signal. If your ICB sits in the bottom quartile, treat the meeting as if a marginal case will be refused — because in your area, it will be. If your ICB sits in the top quartile, prepare to the same standard anyway: high-rate ICBs still refuse cases that arrive with thin evidence, and a refusal in a high-rate ICB is harder to reverse on appeal because the panel can argue the bar was already low.

Whether your ICB sits at 7.3% or 42.5%, the legal test is the same: a primary health need under the National Framework. The framework is the lever; the variation is what happens when it is applied unevenly. If your relative's case overlaps with a dementia diagnosis, our guide on whether dementia qualifies for CHC goes deeper into how the framework reads cognitive cases specifically.

Conclusion

CHC MDT assessments are structured and predictable — preparation is your biggest advantage. Five things to take into the meeting:

• The DST scores 12 domains; a single Priority or two Severe scores triggers a clear eligibility recommendation
• The four characteristics — Nature, Intensity, Complexity, Unpredictability — are the lens assessors use; frame your evidence around them
• The "well-managed needs" principle is the most common reason families under-score; describe what carers do, not how the patient looks
• Where you live affects your outcome — document rigorously regardless of your ICB's historic eligibility rate
• A refused decision is not the end — around one in six are overturned at local review, and prepared evidence is what carries the appeal

If you have an MDT date in the diary, the next two weeks are the highest-leverage time you have. CareAdvocate's Checklist Evidence Pack maps your relative's care records to the 12 DST domains in advance, so the panel sees a structured, indexed evidence document on the day — not a verbal account.

Get the CareAdvocate Checklist Evidence Pack →

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Last reviewed: 5 May 2026. CareAdvocate content is reviewed by legal professionals and social care professionals. We provide CHC advocacy and evidence preparation, not legal advice.