MDT Evidence Pack: Domain-by-Domain Mapping Template for CHC (2026 Free Download)

Only 17% of Standard NHS Continuing Healthcare assessments now end in eligibility — down from 31% in Q1 2017/18 (Healthwatch England, October 2025). The most common reason families lose evidence at the Multi-Disciplinary Team (MDT) meeting isn't missing records. It's unmapped records — twelve months of care notes that never get linked to a specific Decision Support Tool domain.

The DST is a 12-domain framework. Your care records are a thick, unsorted bundle. The panel won't do the mapping for you — and what isn't mapped, isn't scored. This guide gives you a free, fillable template, shows you how to populate it row by row, and explains how to rate severity honestly, so your relative's evidence reaches the panel in the language it actually uses.

Reviewed by legal professionals and social care professionals.

TL;DR: Only 17% of Standard NHS CHC assessments now result in eligibility, down from 31% in 2017/18 (Healthwatch, October 2025). The biggest reason families lose evidence at the MDT is unmapped evidence — care records never linked to a specific DST domain. This guide gives you a free 12-domain mapping template, shows how to populate it from care records, GP notes, and family observations, and explains how to score severity honestly. It's the same structure CareAdvocate uses inside our MDT Prep Pack (£499 upgrade / £799 standalone) — built for families who want to do it themselves.

Get the template: Download the 12-domain DST evidence mapping template (free) — fillable, with a worked example for each domain.

What this post does not cover. This is a tactical template, not a process explainer. For what actually happens on the day of the MDT, read what happens at an NHS CHC MDT assessment. For a general preparation walkthrough, see our assessment preparation guide. For the full journey — Checklist → MDT → Outcome → Appeal — see the full CHC pathway.

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What is the MDT panel actually looking for?

An MDT decides eligibility on four key indicators — nature, intensity, complexity, and unpredictability — assessed across 12 care domains, each scored from No Needs through Low, Moderate, High, Severe, and Priority (National Framework for NHS Continuing Healthcare, July 2022). The panel isn't asking "is your relative unwell?" It's asking how those four qualities show up, domain by domain.

The 12 DST domains are: Behaviour, Cognition, Psychological and Emotional Needs, Communication, Mobility, Nutrition, Continence, Skin Integrity, Breathing, Drug Therapies, Altered States of Consciousness, and Other Significant Care Needs. Each is scored against published descriptors. A primary health need is typically indicated by one domain at Priority, two at Severe, or a strong combination across several domains.

A guardrail before you start. MDT scoring uses Priority / Severe / High / Moderate / Low / No Needs — not A/B/C. A/B/C belongs to the earlier Checklist (Stage 1). If you've read advice that mixes the two, it's describing a different stage — and the confusion costs families real ground in the room. For what the meeting itself involves, see what happens on the day of the MDT.

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The mapping template — what each column does

The template is a 12-row matrix: one row per DST domain, six columns per row — Domain, Observed Behaviour/Need, Evidence Source, Frequency/Severity, Proposed Score (with reasoning), and Well-Managed Flag. Each populated row is a self-contained argument the panel can follow without hunting through your bundle. The whole point is that a populated row beats a verbal summary delivered under pressure on the day.

Here are three worked rows, with realistic redacted entries:

Read the columns left to right. Observed need is plain English. Evidence source is a specific document and date — "Care plan, p.4, 14/03/2026", never "the care home knows". Frequency/Severity is counts and quotes ("3 falls in 90 days"). Proposed Score is the band you'll argue for, tied to the descriptor. And the Well-Managed Flag — the column most families skip — records whether the calm depends on the very support being assessed.

Get the template: Download the 12-domain DST evidence mapping template (free), or browse our CHC evidence templates hub.

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How do you source evidence for each domain?

Five evidence streams feed the template: GP records, hospital discharge summaries, care plan and daily notes, a family observation diary, and specialist reports (SALT, OT, dietitian, mental health team). No single stream covers everything — most domains are built from two or three. Knowing which stream tends to carry which domain saves weeks of searching the wrong file.

Which evidence stream typically carries which DST domain (H = heavy, M = moderate, L = light)

Domain	GP	Hospital	Care notes	Family diary	Specialist
Behaviour	L	L	H	H	M
Cognition	H	M	M	M	H
Psychological / Emotional	M	L	M	H	H
Communication	L	L	M	M	H
Mobility	M	H	H	L	H
Nutrition	M	M	H	M	H
Continence	L	L	H	L	M
Skin Integrity	L	M	H	L	H
Breathing	H	H	M	L	H
Drug Therapies	H	M	H	L	M
Altered States of Consciousness	M	H	M	M	H
Other Significant Needs	M	M	M	M	M

The unlocking step is the Subject Access Request. A SAR to the GP, the hospital, the ICB, and the care home brings the records into your hands — and by law it must be answered within one calendar month (ICO). Without the records, you're arguing from memory; with them, every claim is dated and sourced. See our Subject Access Request guide for the request letters.

One reassurance. Family-written observations count — they aren't "just opinion". A dated diary is the primary source for patterns the clinical record misses, particularly in Behaviour and Cognition. Our guide on how to write a family statement shows the structure.

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Filling severity ratings honestly

Over-claiming destroys credibility; under-claiming hands the panel a low score. The honest rule: if you can't point to evidence supporting a band, drop one band. A score you can defend line by line is worth more than an ambitious one that collapses under the first question. The panel weighs all four indicators — and a moderate-frequency need with high unpredictability can still warrant High or Severe.

Severity bands with example language — Behaviour and Continence (not every domain carries every band)

Band	Behaviour example	Continence example
Priority	Behaviour of such intensity and unpredictability it poses an immediate, serious risk	— (Continence tops at High)
Severe	Frequent, unpredictable challenging behaviour needing a planned, skilled response	— (tops at High)
High	Challenging behaviour needing a structured plan and regular review	Fully dependent; scheduled support day and night, with skin risk
Moderate	Intermittent agitation managed with routine prompts	Occasional support, predictable pattern
Low	Rare, predictable, no skilled response required	Needs reminders only

Notice the gap in the Continence column. Not every domain carries every band — Continence tops out at High, while Behaviour, Breathing, Drug Therapies, and Altered States of Consciousness can reach Priority. Scoring a domain at a band it can't reach is the fastest way to lose the panel's trust on every other row.

The simplest test is the verb. If the care plan reads "managed by…", you have a well-managed need to flag — which is where most evidence quietly leaks away.

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The "well-managed needs" trap — where most families lose evidence

The single biggest reason families lose CHC at the MDT is the panel scoring the managed outcome instead of the underlying need. Paragraphs 162–163 of the 2022 National Framework are explicit: well-managed needs are still needs (DHSC, 2022). A need doesn't shrink because the care package is working — it's being held in check by skilled input, and that input is exactly what CHC funds.

Take a relative whose challenging behaviour is controlled by 24-hour 1:1 staffing and PRN medication. That is not a Low Behaviour need. It's a High or Severe need that's being well-managed — and the score must reflect the unmanaged baseline: what would happen if the support were withdrawn. The same logic runs through three domains families routinely under-score:

• Behaviour — "settled with 1:1" reads as Low to a panel skimming the notes. The unmanaged picture is the score.
• Skin Integrity — "no current pressure damage" can mask a need only prevented by two-hourly repositioning and an air mattress.
• Continence — "no accidents" may depend on a rigorous, staff-led toileting regime, not on continence.

That's what the template's Well-Managed Flag column is for: it makes you state, for every domain, whether the stability is real or manufactured by care. For the law behind it, see well-managed needs — what the law actually says.

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Common evidence gaps and how to plug them

Three gaps show up again and again in family evidence: missing district-nurse notes, no GP medication review, and zero family observation log. Each is fixable — but only with lead time, because a Subject Access Request takes up to a calendar month to return. Start now, not the week before the meeting.

Common evidence gaps and the action that closes each

Gap	Plug
Missing district-nurse notes	SAR to the community nursing service via your ICB
No GP records past 6 months	SAR to the GP surgery (one calendar month response under UK GDPR)
No incident log	Start a 14-day family observation diary now — even a partial log changes the room
Care home notes too thin	Ask for the manager's incident reports separately — daily notes and incident reports are different documents
No specialist input	Request a re-assessment from SALT / OT / mental health via the GP if it's been over 12 months

This is also where 80%+ of the outcome is decided. Of the Standard CHC assessments completed in 2024/25, the great majority ended in refusal (NHS England, 2025) — and the evidence gap is the difference between the cases that succeed and the cases that don't. A thin pack isn't a small disadvantage; it's the disadvantage. For the wider picture of what families experience, see what families say about the CHC process.

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Bringing the pack to the MDT meeting

Print four copies — one for each MDT member, one for you, one spare — and hand them out at the start, led by a one-page evidence index that points to source-document page numbers. Printed beats digital here: the panel needs to write on it, and a pack in their hands is harder to overlook than a file you offer to email later.

A few practical mechanics make the difference. Tab or divide the pack per domain so the panel can turn straight to any row. Bring the original source documents in a separate folder for any verification request. Bring a witness — a second family member or an advocate — because two people catch more than one under pressure. And know your rights in the room: you can ask to record (with consent), challenge a score as it's given, and request that a recorded objection is entered into the meeting notes.

Why the objection matters. A score you let pass is a score you've effectively accepted; a score you challenge on the record is one you can carry into an appeal. The meeting notes are evidence too. For the full run of the day, see what to expect on the day.

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Where this template fits in the full CHC pathway

The 12-domain mapping is a Stage 2 artifact — it's for the MDT after a positive Checklist. The Checklist (Stage 1) is a different, earlier tool: 11 domains scored A/B/C, set deliberately low to decide only whether you proceed to full assessment. This template doesn't belong there. Using A/B/C language at the MDT, or DST severity bands at the Checklist, signals you've mixed the stages.

If you proceed past the MDT to a refusal, the same mapped pack becomes the backbone of an appeal — see how to appeal a CHC decision. For the criteria the whole thing rests on, see the National Framework criteria explained and the 12 DST care domains in detail. And for the journey end to end, see the full CHC pathway.

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Conclusion

The MDT decides on mapped evidence, not raw care records — and what isn't mapped to a domain rarely gets scored. The template's job is to translate twelve months of notes into the panel's own language, row by row, with a source and a date behind every claim.

• Map every domain before the meeting; a populated row beats a verbal summary on the day.
• Score honestly — if you can't evidence the band, drop one.
• Flag well-managed needs in their own column; don't let the panel score the managed outcome.
• Print four copies and bring source documents in a separate folder.
• This is a Stage 2 tool only — A/B/C belongs to the Checklist.

Want the same template built for you — populated by our evidence team and reviewed against National Framework descriptors? The MDT Prep Pack (£499 upgrade / £799 standalone) is the done-for-you version; the free template above is the same structure, just unpopulated. If you've already been refused, the Case Strength Report (£97) triages whether the evidence supports an appeal, and the Checklist Evidence Pack (£597) covers the earlier stage. Not sure where you are yet? Start with our free CHC Eligibility Screener. We provide evidence preparation, not legal advice — but the preparation is the part you can control.

Reviewed by legal professionals and social care professionals.

Frequently asked questions

Can I bring my own evidence pack to the MDT, or does the assessor provide everything?

Yes. The National Framework (July 2022) explicitly entitles you and your representative to submit evidence and to be heard at the assessment. You do not have to rely on the records the assessor has gathered. Most MDT panels welcome a structured, domain-mapped pack — it makes their job faster and the decision easier to evidence.

What if the MDT scores a domain lower than the evidence supports?

Raise the objection in the room, ask for it to be recorded in the meeting notes, and hand the panel the matching row from your mapping template with its source references. A recorded objection becomes part of the written record and forms the basis of any later appeal or Independent Review Panel referral.

Do family observations count as evidence for CHC?

Yes. Family-written observation diaries are valid evidence under the National Framework, especially for domains like Behaviour, Cognition, and Communication, where day-to-day patterns matter more than a clinical snapshot. Date every entry and cross-reference it to the care records — a dated, specific diary carries far more weight than a general statement.

The care plan says my relative is 'settled' — does that lower the CHC score?

Not if that settled state depends on intensive support. Paragraphs 162–163 of the 2022 National Framework state that well-managed needs are still needs. If the calm is produced by 1:1 staffing, secure surroundings, or PRN medication, the score must reflect the unmanaged need — flag it in the Well-Managed column of the template.

What's the difference between the Checklist A/B/C and the MDT severity scoring?

The Checklist (Stage 1) is a screening tool with 11 domains scored A, B, or C. The MDT (Stage 2) uses the full Decision Support Tool with 12 domains scored Priority, Severe, High, Moderate, Low, or No Needs. They are different stages with different scoring systems — this template is for the MDT stage only. Don't mix them.