Domain 1 of 12·PRIORITY-ELIGIBLE

Breathing

Respiratory function and any need for oxygen, nebulisers, suction, ventilation.

New to CHC? Run the free 60-second screener first →

What this domain measures

The Breathing domain captures respiratory function and the clinical support a person needs — from inhalers and nebulisers through continuous oxygen to suctioning, tracheostomy care, and ventilation. It is one of four Priority-eligible domains: a single Priority score in Breathing can secure CHC eligibility on its own. Descriptors turn on whether respiratory needs are routine, predictable, or whether unpredictable crises put the person at immediate risk.

How it's scored (Annex C wording)

DST scoring levels for the Breathing domain, with verbatim Annex C descriptors.
Level	DST descriptor
No needs	Normal breathing, no issues with shortness of breath.
Low	Shortness of breath or a condition which may require the use of inhalers or a nebuliser and has no impact on daily living activities. OR Episodes of breathlessness that readily respond to management and have no impact on daily living activities.
Moderate	Shortness of breath or a condition which may require the use of inhalers or a nebuliser and limit some daily living activities. OR Episodes of breathlessness that do not consistently respond to management and limit some daily living activities. OR Requires any of the following: • low level oxygen therapy (24%). • room air ventilators via a facial or nasal mask. • other therapeutic appliances to maintain airflow where individual can still spontaneously breathe e.g. CPAP (Continuous Positive Airways Pressure) to manage obstructive apnoea during sleep.
High	Is able to breathe independently through a tracheotomy that they can manage themselves, or with the support of carers or care workers. OR Breathlessness due to a condition which is not responding to treatment and limits all daily living activities
Severe	Difficulty in breathing, even through a tracheotomy, which requires suction to maintain airway. OR Demonstrates severe breathing difficulties at rest, in spite of maximum medical therapy OR A condition that requires management by a non-invasive device to both stimulate and maintain breathing (bi-level positive airway pressure, or non-invasive ventilation)
Priority	Unable to breathe independently, requires invasive mechanical ventilation.

Evidence that moves the score up

Oxygen prescription and daily usage log (litres/min, hours/day, saturation targets)
Nebuliser administration frequency and any escalation pattern across the last 12 weeks
Hospital and ambulance admission records for respiratory episodes (last 12 months)
Tracheostomy care records including suctioning frequency, stoma assessments, and inner-cannula change schedule
Respiratory consultant letters, pulmonary function tests, and any sleep-study results
Pulse oximetry trend data and any acute desaturation events recorded by staff
Care plan section describing the trained-staff response required during a respiratory crisis
End-of-life or anticipatory care plan if respiratory deterioration is documented

How ICBs commonly under-score this domain

Pattern: Assessor scored Moderate because the person is 'stable' on continuous oxygen.

Rebuttal: Continuous oxygen is the intervention, not the absence of need. Per the well-managed needs principle, the level must reflect the present-day need if oxygen were withdrawn — which would typically be hypoxia, distress, and clinical deterioration within hours.

Source: para 162-166 + DST user notes para 31

Pattern: Assessor scored High instead of Severe because respiratory episodes are 'managed' by skilled nursing.

Rebuttal: Severe descriptor explicitly contemplates respiratory needs requiring suctioning, emergency medication, or rapid escalation. Successful skilled-nursing management is evidence the need IS Severe — not that it has been reduced.

Source: DST Annex C Breathing Severe descriptor

Pattern: Assessor scored Severe instead of Priority because the person is not ventilator-dependent.

Rebuttal: Priority descriptor turns on whether respiratory needs create an immediate and serious risk requiring skilled response at all times. Ventilator dependency is one route to Priority — not the only one. Tracheostomy with continuous suctioning, brittle COPD with frequent unpredictable arrests, or end-stage neurological respiratory failure can all meet Priority.

Source: DST Annex C Breathing Priority descriptor

4-line rebuttal template

I disagree with the [LEVEL] score for Breathing. The evidence shows [SPECIFIC PATTERN] which meets the [HIGHER LEVEL] descriptor. On [DATE/PERIOD], [DESCRIBE EPISODE OR CARE — oxygen demand, saturation values, nebuliser frequency, suctioning needs, hospital admission, trained-staff response required]. Per the well-managed needs principle (National Framework paras 162–166), the current [OXYGEN/NEBULISER/SUCTION/VENTILATION] regime is the intervention, not the absence of need. If [SUPPORT] were withdrawn, the present-day need would be [DESCRIBE RISK]. I therefore request the Breathing domain be re-scored to [HIGHER LEVEL] with reference to the [SPECIFIC EVIDENCE: oxygen logs / nebuliser charts / admission records / saturation trend data].

Breathing is one of four Priority-eligible domains

A single Priority score in Breathing can secure CHC eligibility on this domain alone. The MDT Preparation Pack (£799) walks through exactly how to prepare your Breathing evidence for the MDT.

View MDT Preparation Pack →