Must the CCG provide us with a copy of the DST?

A: Yes. If you are the patient or their representative, the CCG must supply the completed DST  when writing to you with the outcome of the decision on eligibility for CHC funding.

You may also have been able to be provided with the DST while it was being completed. The Decision Support Tool is the document that the MDT (multidisciplinary team) use to  set out the individual’s needs in relation to 12 care domains. The MDT then makes a recommendation on eligibility for CHC funding.

It is clear from the National Framework documentation that the individual or their representatives (eg a family member, who by the way does not have to have Lasting Power of Attorney to fulfill this role) can be present when the DST is being completed (PG30.3) and would therefore have knowledge of its contents – or, at least, the “outcome”. (See PG 30.4)

Paragraph 10 of the DST says: “The individual and their representative(s) should be given sufficient notice of completion of the DST to enable them to arrange for a family member or other advocate to be present.”

30.3   The individual and/or their representative should be fully involved in the process and be given every opportunity to contribute to the MDT discussion. However, once all the information  has  been  gathered  (and  depending  on  agreed  local  protocols)  it  is acceptable for the MDT to have a discussion without the individual and/or their representative present in order to come to an agreed recommendation. MDTs should be aware that the DST contains a section at the end of the domain tables for the individual and/or the representative to give their views on the completion of the DST that have not already been recorded elsewhere in the document, including whether they agree with the  domain  levels  selected.  It  also  asks  for  reasons  for  any  disagreement  to  be recorded. Therefore the MDT meeting should be arranged in a way that enables that individual to give his/her views on the completed domain levels before they leave the meeting.

30.4   If the individual and/or their representative are not present for the part of the meeting where  the  MDT  agrees  the  recommendation  regarding  primary  health  need,  the outcome should be communicated to them as soon as possible.

NB Note that the DST was revised in June 2016 but with (so far as I can see) no significant changes  to its content. I will make any necessary revisions in due course to this website.

The Decision Support Tool document 2013 specifies (paragraph 20) that:

20.       A copy of the completed DST (including the recommendation) should be forwarded to the individual (or, where appropriate, their representative) together with the final decision made by the CCG, along with the reasons for this decision.

This paragraph, with effect from April 2013, was slightly reworded from the now out-of-date 2009 version, which said: (Paragraph 8.7i, page 50) “The decision should be communicated in writing as soon as possible in an accessible format and language to the individual or their representative so that it is meaningful to them. They should also be sent a copy of the DST …” Practice guidance 2010 (NB now superseded by 2013 PG)

So why might a CCG have an (unlawful) policy of NOT supplying the full DST to the individual or their representative?

  • They may have staff who are not yet aware of the requirements of the National Framework.
  • Staff may be aware of the existence of the requirements but are choosing not to adhere to them, perhaps because they believe it doesn’t matter very much whether they follow the rules or not, or because they don’t agree with them, or they don’t have the time to photocopy a large document.
  • The CCG may, because of concerns about patient confidentiality, have a policy of not disclosing medical records to anyone without an LPA for health and welfare, and managers have judged that compliance with their own internal policy somehow over-rides the National Framework. (See the role of the Caldicott Guardian)
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One Response to Must the CCG provide us with a copy of the DST?

  1. Chris Gallagher says:

    Greater East Midlands Commissioning Support Unit. (GEM CSU) in their standard letters in regard to CHC refusals actually require the patient to ask for “a DST”.
    1. They are clearly instructed to send it. So they have blatantly decided to break the rules.
    2. What the heck is a DST? If you have never seen one would you understand its significance?
    3. It is obvious why they don’t send it as they are required. They don’t want anyone to appeal.
    4. GEM CSU also saves an enormous amount of cash that is soon (2016) to be profit, by not having staff photocopying 50 or so pages for thousands of patients every year.

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