The CHC MDT meeting: how families can prepare

The CHC MDT meeting is where the multidisciplinary team (MDT) assessing your relative for NHS Continuing Healthcare (CHC) completes the Decision Support Tool and agrees a recommendation on whether there is a primary health need. In England it follows a positive Checklist and comes before the integrated care board (ICB) decides. Families are not members of the team, but the rules expect them to be told, heard and recorded. This guide explains how to prepare for a CHC assessment: who sits on the team, what you can say, what to bring and the questions to ask before the team decides.

What the CHC MDT meeting is for

After a Checklist shows that a full assessment is needed (see our Checklist guide), the National Framework says a multidisciplinary team must assess whether the person has a primary health need using the Decision Support Tool (DST). The team makes a recommendation and the ICB decides, departing from it only in exceptional circumstances and for clearly stated reasons.

You may hear it called the DST meeting or the continuing healthcare assessment meeting. The team gathers evidence, records a level for each of the 12 care domains (see the 12 DST care domains) and writes a recommendation covering the four key characteristics of need: nature, intensity, complexity and unpredictability.

Primary health need is not decided by diagnosis or by where someone lives. The framework looks at the person's actual day-to-day needs in their totality, and at whether the main aspects of the care are focused on addressing or preventing health needs. If a clinician decides the person has a rapidly deteriorating condition that may be entering a terminal phase, a Fast Track form replaces the Checklist and this meeting (see our Fast Track guide).

Who sits on the CHC multidisciplinary team

The regulations set a minimum: two professionals from different healthcare professions, or one healthcare professional plus one person responsible for assessing care and support needs under Part 1 of the Care Act 2014. The framework says the team should usually include health and social care professionals who know the person, and the ICB must consult the local authority as far as is reasonably practicable.

A case co-ordinator is normally named. Under the DST guidance they make sure the completed tool and signed recommendation reach the ICB, tell the person that a decision normally follows within 28 calendar days and check for urgent or interim support needs. Ask for their contact details when the invitation arrives.

Neither the person nor the family is a member of the MDT. The framework's practice guidance says they cannot be members but should be fully involved and given every opportunity to contribute.

Before the meeting: notice, format and what to ask

The DST guidance says the person should be invited to be present or represented wherever practicable, with reasonable notice so that a family member can attend. If that is not practicable, the team should obtain and consider their views and record how they contributed or why they did not. Video, telephone and hybrid meetings are all mentioned, and the framework calls it best practice for assessors to meet the person beforehand.

When the invitation arrives, ask the co-ordinator who will attend, whether the local authority is taking part, which records the team already holds, whether a family member can join by video and when you will hear the recommendation.

Timing matters too. The framework says an assessment in an acute hospital is unlikely to reflect longer-term needs accurately and is better done after discharge and recovery, although assessment should not delay a safe discharge. If your relative is on a ward, ask where and when the team plans to assess and why.

Consent and lasting power of attorney: what the team can share with you

The DST guidance says explicit consent is needed before personal data is shared with a third party, though not between the professionals carrying out the assessment. Guidance from the Department of Health and Social Care, published on 8 May 2026, says consent is normally sought at the Checklist stage and recorded on the NHS continuing healthcare consent form. The person can agree to share some or all of their information with different people and can withdraw consent at any stage. Where consent has been given, the family's views and knowledge should be taken into account.

If the person cannot make that decision, the Mental Capacity Act 2005 applies. An attorney under a lasting power of attorney or a court-appointed deputy with the relevant authority decides; otherwise the responsible professional makes a best interests decision. The type of power matters. An attorney for property and financial affairs cannot consent to health and welfare matters, although Age UK's factsheet notes that someone acting in the person's best interests, including a finance attorney, can legitimately ask for information in order to challenge a decision.

Before the meeting, check that the consent form names you or that the team holds the right paperwork. The same principle applies to us: our free preview asks you to confirm that the person agrees to you sharing their details, or that you act for them under a lasting power of attorney.

Your role: the person's own view and the family's knowledge

The framework says the person's own view of their needs, with any supporting evidence, "is given appropriate weight alongside professional views". The DST has a section for the person or their representative to record views on the completed levels, including disagreement, and the practice guidance says the meeting should let them give those views before they leave.

Family members often know what a visiting professional cannot see: what the nights are like, how the person behaves when tired or frightened, what they used to manage. The practice guidance says oral evidence from carers should be taken into account and recorded on the DST. Give dates and numbers, and ask for it to be written down.

What evidence to bring, and how much

The framework's practice guidance lists sources that can inform the DST, and says the list is not exhaustive: care home or home support records, the care plan, a 24-hour or 48-hour diary of needs and interventions (with good day and bad day versions if needs fluctuate), GP information, falls risk assessments, specialist assessments and carers' views.

Volume is not the aim. Evidence exists to give an accurate picture, sufficiency depends on how pertinent it is and a summary or chart of how often something happened may help more than a pile of original forms. A short, dated folder works best:

• Provider records: food and fluid, repositioning, continence, falls, behaviour and medication charts. Not every provider records in detail, and the framework says a provider can be asked to keep a diary over a suitable period.
• Clinical letters: discharge summaries, specialist and therapy letters.
• A family diary: three to seven days, using the table below.
• The person's own words about their needs, if they can tell you.
• Authority paperwork: any lasting power of attorney that supports your involvement.

Be specific. NHS England's independent review guide gives the example of saying a problem usually happens two or three times a day rather than a lot.

Describing needs through the four characteristics

The framework says each characteristic may, alone or in combination, show a primary health need. Its practice guidance offers prompts for the team, which translate into family questions:

• Nature: what the need is like and what care it takes. Does it need particular skill, and what happens if it is not done on time?
• Intensity: how severe it is, how often care is needed, how long each time and how many carers at once.
• Complexity: whether one problem makes another harder. A physical problem can lead to a mental health need.
• Unpredictability: how much needs change, whether anyone can see them coming and what happens if care is late.

Mental and emotional needs count as much as physical ones, and so does care that relatives give. The DST guidance also says levels cannot be equated: several moderate needs are not the same as one high need.

Well-managed needs are still needs

A familiar line in a refusal is that the care home is managing well. The framework says a need should not be marginalised just because it is successfully managed. Only where management has permanently reduced or removed an ongoing need does that bear on eligibility. Ask the team to record both the need and the care that keeps it managed. The framework also says decisions should not rest on diagnosis, the setting, the provider's ability to manage care or any other rationale about inputs rather than needs.

One condition, several domains

The DST guidance says a single condition can create needs in several domains, and each is recorded and weighted in its own right. So describe the person across the whole tool, not only the headline problem.

The guidance also explains the markers. A clear recommendation of eligibility is expected with a priority level in any of the four domains that have one (breathing; behaviour; drug therapies and medication; and altered states of consciousness) or with two or more severe needs across all domains. A severe need alongside needs in other domains, or several high or moderate needs, may also indicate a primary health need. The framework adds that these are indicative guidelines rather than a score.

On the day: domain by domain

Ask the team to go through the domains in order, saying which level it proposes and what evidence supports it. The DST guidance says reasons should be transparent and clearly documented and every section completed. For each domain, listen, add what you have seen that the team may not have, check that it has been written down and, if you disagree, say so and point to the record that supports you.

If you disagree with a level

Practitioners who cannot agree between two levels should choose the higher and record the evidence. That rule is for disagreement between practitioners. The practice guidance (note 33) says it does not apply when the person or their representative disagrees, because they are not members of the MDT. Instead their concerns should be fully considered by reviewing the evidence, and any disagreement that remains should be recorded in the DST. Note 32 also warns that the higher-level practice must not be used to steer people towards a decision that is not justified.

So disagreeing does not move a level, and you should not expect it to. Bring evidence, ask how each level was chosen and make sure remaining disagreement is on the record. You will read that record if you later need to challenge the decision, as covered in our local resolution and independent review guide.

Deterioration, review and the recommendation

Ask about the future. For a slowly deteriorating condition, levels reflect current needs, but likely change should be recorded and can lead to eligibility now or an early review date. The written recommendation should summarise needs including the person's own view, address all four characteristics and the interactions between domains and say whether there is a primary health need.

The team may agree its recommendation without you present. The practice guidance accepts that, but says you should be able to give your views on the completed levels before you leave, and be told the outcome as soon as possible if you were absent.

Fourteen questions to ask at or before the meeting

Each reference is the paragraph of the DST guidance (para) or the National Framework (NF) that supports asking. Print the list and take it with you.

After the meeting

The co-ordinator sends the completed DST and signed recommendation to the ICB. The framework expects a response within 48 hours (two working days) and, in most cases, a decision within 28 calendar days of the ICB receiving the positive Checklist. Checking the recommendation, by an individual or a panel, should not be used as gatekeeping or financial control.

You should receive the decision in writing with the reasons, a copy of the completed DST, a contact for questions and details of how to request a review. If the answer is no, see what to do after a refusal. If it is yes, expect a review within three months and then at least annually, because eligibility is not indefinite.

Delay carries a financial rule. If the ICB unjustifiably takes more than 28 calendar days and then finds the person eligible, Annex E of the framework says it should refund the cost of services paid for by the person or the local authority from day 29. The ICB can show the delay was reasonable, for example where a third party was slow to send records or the family was slow to supply essential information, so answer the co-ordinator's requests promptly. In general, existing care should continue while the decision is awaited.

CHC assessment tip: describe the typical day and the worst day, truthfully

The point of the evidence is an accurate picture, not a persuasive one. The practice guidance says its purpose is to establish needs correctly, not to prove to a court that anyone is telling the truth. Describe what usually happens, what happens on bad days, how often each occurs and what the person can still do with help.

Many people play things down in front of professionals, and families can find themselves saying "she manages" out of loyalty. The opposite mistake is just as unhelpful: describing needs that are not there damages your credibility on the points that are true. Nobody can make a level go up. A good record makes sure the real picture is in front of the team.

Common questions