Domain 6 of 12

Communication

Ability to communicate needs, understand information, and interact meaningfully.

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What this domain measures

The Communication domain captures the ability to communicate needs, understand information, and interact meaningfully with carers and family. It has 4 descriptor levels — no Severe, no Priority. The fight is typically Moderate vs High, particularly where communication breakdown means unmet needs, undetected pain, or inability to consent to care decisions go unrecognised.

How it's scored (Annex C wording)

DST scoring levels for the Communication domain, with verbatim Annex C descriptors.
Level	DST descriptor
No needs	Able to communicate clearly, verbally or non-verbally. Has a good understanding of their primary language. May require translation if English is not their first language.
Low	Needs assistance to communicate their needs. Special effort may be needed to ensure accurate interpretation of needs or additional support may be needed either visually, through touch or with hearing.
Moderate	Communication about needs is difficult to understand or interpret or the individual is sometimes unable to reliably communicate, even when assisted. Carers or care workers may be able to anticipate needs through non-verbal signs due to familiarity with the individual.
High	Unable to reliably communicate their needs at any time and in any way, even when all practicable steps to assist them have been taken. The individual has to have most of their needs anticipated because of their inability to communicate them.

Evidence that moves the score up

Speech & Language Therapy (SALT) assessments and any AAC (augmentative communication) recommendations
Care plan section on adapted communication methods and which staff can use them
Examples of communication breakdown with consequences — unmet need, missed medication, undetected pain
Pain assessment tool used (Abbey Pain Scale, PAINAD) and frequency of pain identification difficulty
Consent and Best Interests decision documentation reflecting communication limits
Hearing and vision assessment with current aids in use
Family/advocate involvement records — interpretation that only familiar people can provide
Records of distress episodes where staff could not determine the cause

How ICBs commonly under-score this domain

Pattern: Assessor scored Low because the person 'communicates basic needs to familiar carers'.

Rebuttal: Familiar-carer-only communication is itself a Moderate-level indicator — the descriptor turns on communication being difficult to understand or interpret, or sometimes unable to reliably communicate even when assisted. If unfamiliar staff (weekend/agency cover, hospital admissions, GP visits) cannot reliably understand the person, Moderate is the floor.

Source: DST Annex C Communication Moderate descriptor

Pattern: Assessor scored Moderate because the SALT assessment was done two years ago and 'is no longer current'.

Rebuttal: An out-of-date SALT assessment is not a reason to score lower — it is a reason to request a current SALT review. Existing evidence of communication breakdown (distress episodes, undetected pain, missed needs) supports the higher descriptor in the absence of a current formal assessment.

Source: common ICB pattern — no published source

Pattern: Assessor scored Moderate instead of High where staff cannot reliably identify pain or distress.

Rebuttal: The High descriptor turns on the person being unable to reliably communicate their needs at any time and in any way, even when all practicable steps have been taken. Pain and distress ARE 'needs'. If recorded distress episodes occur where staff cannot determine the cause despite using all available aids, the High descriptor is met.

Source: DST Annex C Communication High descriptor

4-line rebuttal template

I disagree with the [LEVEL] score for Communication. The evidence shows [SPECIFIC PATTERN — pain identification failure / breakdown with unfamiliar staff / unmet need] which meets the [HIGHER LEVEL] descriptor. On [DATE/PERIOD], [DESCRIBE: distress episode, identification difficulty, response of unfamiliar staff, clinical consequence]. Per the well-managed needs principle (National Framework paras 162–166), the [familiar staff / AAC system / pain assessment tool] is the intervention, not the absence of need. If [SUPPORT] were withdrawn, the present-day risk would be [DESCRIBE: undetected pain, missed clinical change]. I therefore request the Communication domain be re-scored to [HIGHER LEVEL] with reference to the [SPECIFIC EVIDENCE: SALT assessment, pain assessment tool records, distress episode log].

Communication rarely secures eligibility on its own

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