Understanding the purpose of the 12 domains
While various frameworks exist in the health and social care sector, the specific 12 domains that are often referred to belong to the NHS Continuing Healthcare (CHC) eligibility process. This national framework helps health and social care professionals assess an individual's complex, ongoing care needs. These domains are evaluated to measure the nature, complexity, intensity, and unpredictability of a person's needs. The outcome determines if the primary need is for healthcare, which is the key to qualifying for full NHS funding.
The 12 Continuing Healthcare domains explained
During a CHC assessment, a multidisciplinary team (MDT) uses a decision support tool (DST) to review a person's needs across these 12 areas. Each domain is given a score (low, moderate, high, severe, or priority) to determine eligibility.
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Breathing This domain assesses an individual's ability to breathe without assistance. It considers conditions like chronic obstructive pulmonary disease (COPD), asthma, or chest infections. The assessment looks at how much support is needed for managing airway obstructions, performing suctioning, or using breathing apparatus.
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Nutrition – Food and Drink This domain focuses on how an individual's nutritional and hydration needs are met. This includes difficulties with swallowing (dysphagia), requiring assisted feeding (e.g., tube feeding via PEG), or needing support to eat and drink safely. The complexity of managing these needs is a critical factor.
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Continence The continence domain evaluates the management of bowel and bladder function. It assesses the level of support required for issues like incontinence, constipation, urinary tract infections, and the use of equipment such as catheters. It looks at the frequency and complexity of care needed to maintain hygiene and dignity.
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Skin and Tissue Viability This domain concerns the condition of the skin and potential for skin breakdown. It includes the prevention and treatment of pressure sores, wounds, ulcers, and other skin conditions. The assessment considers the care required, such as repositioning schedules, wound dressing changes, and management of specific skin issues.
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Mobility Mobility covers a person's ability to move around and reposition themselves. This includes transferring from a bed to a chair, walking with or without aids, or needing to be moved by a hoist. It also assesses the risks associated with mobility and the level of assistance required.
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Communication The communication domain evaluates an individual's ability to make their needs known and understand others. This can involve verbal communication difficulties, the use of non-verbal communication methods, or challenges due to cognitive decline affecting their ability to communicate effectively. It looks at the impact on their care and safety.
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Psychological and Emotional Needs This domain assesses a person's mental health and emotional well-being. It considers issues such as depression, anxiety, agitation, and challenging emotional responses. The intensity of care required to provide reassurance, manage distress, or support mental health is evaluated.
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Cognition Cognition refers to an individual's mental processes, including memory, orientation, and decision-making. This domain assesses needs related to dementia, brain injury, or learning disabilities. The unpredictability and complexity of a person's cognitive function and their impact on care are key.
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Behaviour This domain is for assessing behaviours that challenge, which may pose a risk to the individual or others. These behaviours can be a result of a medical condition or cognitive impairment. The assessment focuses on the management of aggression, resistance to care, or other behaviours that require specialised interventions.
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Drug Therapies and Medication: Symptom Control This assesses the management of medication, including administering, monitoring, and controlling symptoms. It considers the frequency and complexity of a person's medication needs, including pain management, and the skills required by staff to administer it safely.
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Altered States of Consciousness This domain is for individuals who experience periods of semi-consciousness, such as those with epilepsy or who have had a stroke. It assesses the care needed during these altered states and the level of monitoring required to ensure safety.
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Other Significant Care Needs The final domain is a catch-all for any complex needs that do not fit into the previous 11 categories but are nonetheless significant. This ensures that a person's overall care picture is considered. Common examples include fatigue, fluctuating needs, or complex medical needs not covered elsewhere.
CHC domains vs. other health and social care frameworks
It is important to differentiate the CHC domains from other domain frameworks used in health and social care. While CHC focuses on individual care eligibility, other frameworks address broader aspects of healthcare or public health.
| Feature | 12 CHC Domains | Agency for Healthcare Research and Quality (AHRQ) Six Domains of Quality |
|---|---|---|
| Purpose | To determine eligibility for NHS-funded long-term care by assessing individual needs. | To provide a framework for evaluating and improving the overall quality of healthcare systems. |
| Focus | Specific, clinical care needs of an individual patient. | System-wide quality attributes like safety, efficiency, and equity. |
| Number of Domains | 12 | 6 (Safe, Effective, Patient-Centered, Timely, Efficient, Equitable) |
| Application | Individual assessment for a specific care package. | Broad evaluation of healthcare delivery across organisations. |
The next steps after a CHC assessment
After the MDT completes the assessment using the 12 domains, a recommendation is made regarding the individual's eligibility for NHS Continuing Healthcare. If deemed eligible, the NHS funds the entire cost of the person's care package. If not, the individual may be referred to local authority-funded social care, though a significant contribution may be required based on means-testing. Understanding these domains is vital for families navigating the complex process.
It is highly recommended to seek professional guidance when preparing for or appealing a CHC assessment. For more detailed information on the official framework, you can refer to the NHS Continuing Healthcare decision support tool guidance on the UK government website. Advocating effectively requires a solid understanding of how a person's needs map onto these categories, as overlooked details can significantly impact the outcome.
Conclusion: The importance of comprehensive assessment
The 12 domains in health and social care provide a structured and comprehensive method for evaluating complex care needs, particularly in the context of NHS Continuing Healthcare. They ensure that all significant aspects of an individual's health are considered, leading to a fair and accurate assessment of their care requirements. For families and care professionals alike, a thorough understanding of these domains is the first step toward securing the appropriate support for those in need.
