MDT meaning: What is an MDT meeting in NHS Continuing Healthcare?

What does MDT mean?

MDT stands for multidisciplinary team. 

The term is used across health and social care in different contexts. For NHS Continuing Healthcare, it refers to the professionals responsible for carrying out the full assessment of a person’s eligibility. 

NHS Continuing Healthcare, often abbreviated to CHC, is a package of ongoing care arranged and funded solely by the NHS for an adult who is assessed as having a primary health need. Eligibility depends on the nature and extent of the person’s assessed needs. It is not determined by a particular diagnosis, the care setting or the person’s financial circumstances. (GOV.UK) 

An MDT meeting may also be described as a full CHC assessment or Decision Support Tool meeting. Although these expressions are sometimes used interchangeably, the multidisciplinary team is the assessors, while the Decision Support Tool is the document they use to record and evaluate the person’s needs. 

When does an MDT meeting take place?

For most people, the CHC process begins with an NHS Continuing Healthcare Checklist. The Checklist is a screening tool used to identify whether a person requires a full eligibility assessment. It does not make the final decision about CHC funding. (GOV.UK) 

Where the Checklist is positive, the person should be referred for a full assessment. The Integrated Care Board, known as the ICB, is responsible for arranging the assessment and making the eventual eligibility decision. 

The MDT should review the person’s health and social care needs in detail. This usually involves considering care records, clinical evidence and information from the person, their family and the professionals involved in their care. 

A separate Fast Track process may apply where an appropriate clinician considers that the person has a rapidly deteriorating condition and may be entering a terminal phase. In that situation, it may not be appropriate to wait for the standard MDT process. 

Who should be part of the multidisciplinary team?

Under the National Framework, the multidisciplinary team should include at least two professionals from different healthcare professions, or at least one healthcare professional and one social care professional.  

The professionals should have relevant knowledge of the person’s needs. Depending on the circumstances, participants may include: 

• an NHS CHC nurse assessor; 

• a social worker; 

• a community nurse; 

• a care home nurse; 

• a mental health professional; 

• an occupational therapist; 

• another clinician involved in the person’s care. 

The NHS states that the MDT should usually include health and social care professionals who are already involved in the person’s care. (nhs.uk) 

In practice, families may find that not every relevant professional attends, and the MDT is just a nurse assessor and a social worker. Information may be provided through reports, care records, or written assessments. This does not invalidate the process, but you should consider whether the team had sufficient current and reliable evidence to understand the full extent of the person’s needs. 

For example, it may be difficult to assess complex behavioural needs without meaningful input from those who manage the behaviour each day. Equally, a brief summary may not adequately reflect fluctuating symptoms, repeated interventions or risks that are controlled through intensive care. 

Can the individual and their family attend?

The person being assessed should be at the centre of the process and they should be given a reasonable opportunity to participate, where they have the capacity and desire to do so. 

They should be invited to attend and participate in the MDT meeting, which may take place face to face or remotely (NHS England). 

A family member, representative or advocate may also attend, where this is appropriate.  

Family involvement can be important because relatives often understand the history, frequency and consequences of the person’s needs. They may also be able to identify where written records are incomplete or where a professional’s account does not match the care being delivered. 

Attendance should not be treated as a formality. You should have an opportunity to explain the needs, refer to supporting evidence and comment on the proposed descriptions and levels of need.What happens before an MDT meeting?

Before the meeting, the ICB should gather sufficient information to support a comprehensive assessment. 

You may receive notice of the meeting and information about attendees. You should also be told how you can contribute. If the meeting is scheduled at short notice or you have not received key records, ask whether there is sufficient time to prepare. 

Useful documents may include: 

• current and historic care plans; 

• daily care notes; 

• medication records; 

• risk assessments; 

• hospital and GP records; 

• nursing records; 

• incident and accident reports; 

• behaviour monitoring charts; 

• nutrition and weight records; 

• skin integrity records; 

• falls records; 

• continence records; 

• reports from therapists or specialist clinicians. 

Do not assume the MDT has obtained all relevant documents. Ask which records will be reviewed and identify any gaps. 

It can also help to prepare examples showing what care is required on an ordinary day, what happens when the person’s condition changes and what risks would arise without support.  

REMEMBER: Managed needs are still needs. The fact that medication, supervision or skilled intervention reduces a risk does not mean the underlying need has disappeared. 

What happens during the MDT meeting?

The MDT completes the Decision Support Tool, commonly called the DST. 

The DST brings together relevant information and supports an evidence-based recommendation as to CHC eligibility. It should be completed as part of a comprehensive assessment of the person’s health and social care needs. 

The document considers needs across 12 care domains: 

• breathing 

• nutrition; 

• continence; 

• Skin (including tissue viability); 

• mobility; 

• communication; 

• psychological & emotional needs; 

• cognition; 

• behaviour; 

• drug therapies and medication; 

• altered states of consciousness; 

• other significant care needs. 

A level of need is selected within each domain. The available levels vary between domains and can include No Needs, Low, Moderate, High, Severe and Priority. Each level has a “descriptor”, and the assessors must decide which is the best match for the person’s needs.  

The levels of need are important, but the assessment should not become a numerical exercise. The team must consider whether the totality of the person’s needs amounts to a primary health need. 

How does the MDT consider a primary health need?

The multidisciplinary team should consider four key characteristics: 

Nature concerns the type of needs involved, their effects and the interventions required to manage them. 

Intensity looks at the quantity, severity and continuity of care needed. 

Complexity considers how different needs interact and whether those interactions make the care more difficult to manage. 

Unpredictability relates to the extent to which needs fluctuate, create unexpected challenges or require timely intervention to avoid harm. 

These “key characteristics” are the primary health need test. If one or more of the characteristics applies, the person has a primary health need and is eligible for CHC funding. 

The primary health need test should reflect the person’s overall needs and day-to-day care requirements. A diagnosis does not establish eligibility by itself, but  a person should not be excluded simply because their condition is common among older or disabled people. 

The setting is also not decisive. A person may qualify for CHC whether they live in their own home, a residential care home or a nursing home. 

Common problems at MDT assessments

What should happen according to the National Framework does not always match a family’s experience of the process. 

Potential concerns include: 

• the assessors never having met the individual and seeming to have a poor understanding of their needs;  

• important care or medical records being missing; 

• relying on a current snapshot rather than looking at the person’s needs over time; 

• describing a need as “managed” without recording the care required to manage it; 

• overlooking the frequency of interventions; 

• recording risks without considering their potential likelihood or consequences; 

• treating needs in isolation rather than examining how they interact; 

• understating needs because the person appeared settled during a short visit; 

• giving greater weight to general statements than detailed daily records; 

• failing to record the family’s disagreement; 

• focusing on diagnosis rather than the actual care required. 

Not every disagreement means the assessment is wrong. Different professionals can reach different evidence-based views. However, the reasons for each selected level of need and overall conclusion should be clear and supported by the available records. 

Question any descriptions that do not reflect your relative’s daily needs. Request that your comments and any disagreements are recorded in the DST. 

What happens after the MDT meeting?

At the end of the assessment, the MDT makes a recommendation as to whether the person is eligible for NHS Continuing Healthcare. 

The final decision is made by the ICB. The National Framework indicates that ICBs should usually accept the MDT’s recommendation, except in exceptional circumstances where there are good reasons to depart from it. 

You should receive a formal outcome letter shortly after the MDT assessment. You should also receive a copy of the completed Decision Support Tool. 

Review the document carefully. Consider the following: 

• whether the descriptions are factually accurate; 

• whether relevant evidence has been included; 

• whether disagreements are recorded; 

• whether the selected levels match the evidence; 

• whether the four key characteristics have been considered in sufficient detail; 

• whether the final recommendation follows from the findings. 

If the decision is negative, the letter should explain how it can be challenged. The strength of any challenge will depend on the evidence, the content of the DST and whether the National Framework was applied correctly. 

How to prepare for your MDT meeting

Begin preparing as soon as you receive notice of the assessment. 

Request relevant records and review them alongside the DST care domains. Note any inaccuracies, gaps, or inconsistencies. 

Focus on the care that is actually required rather than the diagnosis alone. Use specific examples. Explain how often interventions are needed, who provides them, what skill is involved and what could happen if care were delayed or omitted. 

Also consider how different needs interact. For example, cognitive impairment may affect communication and medication compliance. Limited mobility can increase risks related to skin integrity, continence, and nutrition. Behavioural issues may make essential care more challenging. 

These connections can be lost when each domain is discussed separately. 

How Farley Dwek can assist with an MDT assessment

An MDT meeting takes place before the ICB reaches its eligibility decision. Early specialist support can help ensure that relevant evidence is identified and the person’s needs are accurately presented before the assessment record becomes the basis of a refusal. 

Through our MDT Advocacy Service, a qualified and experienced CHC nurse can: 

• review care and clinical evidence before the meeting; 

• help identify missing or understated needs; 

• attend the MDT assessment with you; 

• explain how the evidence relates to the DST domains; 

• question proposed levels where they do not reflect the records; 

• ensure relevant interactions and risks are brought to the team’s attention; 

• help you understand the recommendation and the next steps. 

The role of an advocate is not to guarantee eligibility or argue for unsupported scores. It is to ensure that the assessment reflects the evidence and that the National Framework is applied to the person’s actual needs. 

If you have been invited to an MDT meeting and are concerned about how your relative’s needs will be presented, speak to Farley Dwek for an initial discussion about our MDT Advocacy Service.