NHS Continuing Healthcare Fast Track

CHC Fast Track is a quicker route to NHS Continuing Healthcare funding for someone with a rapidly deteriorating condition who may be entering a terminal phase. When a person is nearing the end of their life, a long assessment is the last thing a family needs, and this route exists to avoid it. This guide explains in plain English how fast track continuing healthcare works: what the test is, who can start it, what families can do, how quickly care should begin and what happens at review. It covers England only. Wales, Scotland and Northern Ireland have their own arrangements.

What Fast Track is

NHS Continuing Healthcare is a package of ongoing care arranged and funded solely by the NHS for an adult who has a primary health need. Most people reach it through several stages: a Checklist to screen for a full assessment, then a meeting of professionals that completes the Decision Support Tool across 12 care domains. Fast Track skips both.

The National Framework (revised 2022) says the Fast Track Pathway Tool exists to identify people who need CHC quickly, with minimum delay. A properly completed tool, giving clear reasons why the person meets the criteria, is by itself enough to establish eligibility. Regulation 21(8) and (9) of the Standing Rules Regulations 2012 puts this into law: where an appropriate clinician decides a person has a primary health need because of a rapidly deteriorating condition that may be entering a terminal phase, the usual assessment steps do not apply and the ICB must decide the person is eligible on receiving the tool. In these cases it is the clinician, not the ICB, who determines the primary health need.

The CHC Fast Track criteria: one test

Both parts must be true: the person has a rapidly deteriorating condition, and that condition may be entering a terminal phase. There is no list of qualifying diagnoses, no required care setting and no score to reach in any of the 12 care domains.

The framework warns against reading the test narrowly. “Rapidly deteriorating” does not only mean a short, specific time left. Nor is “may be entering a terminal phase” limited to situations where death is imminent. The clinician decides on the facts of the person's case and healthcare needs at the time.

Who can complete the Fast Track Pathway Tool

The tool is completed by an “appropriate clinician”. Regulation 21(13) defines this as someone who is responsible for the diagnosis, treatment or care of the person and who is a registered nurse or a registered medical practitioner. Both parts matter. The framework adds that the clinician should know the person's health needs well enough to explain why the criteria are met. Clinicians in voluntary and independent organisations with a specialist end of life role, such as hospices, can count too, provided they offer services under the National Health Service Act 2006.

So a doctor or nurse who is treating the person can be an appropriate clinician, including a hospice doctor or nurse. Someone who is not a registered nurse or registered medical practitioner, such as a family member or a care assistant, cannot complete the tool, however well they know the person.

What families and care staff can do

The framework says people who support someone at the end of life but are not appropriate clinicians themselves, including staff in care homes and voluntary organisations, can contact the responsible clinician and ask for the tool to be considered. Nothing stops a family member asking the same question, and it is a fair one to ask.

• Ask the clinician directly. For example: “Could Mum be considered for Fast Track NHS Continuing Healthcare?” Ask whichever clinician is responsible for the person's care, such as the GP, the hospital or palliative care team, the hospice team or the community nurse.
• Describe what has changed. Say how health has declined recently and what help is now needed day and night. It helps if the form shows how the person is at present and how they are likely to progress, although ICBs should not make that a condition of eligibility.
• Say where the person wants to be. If they want to stay in their care home or be cared for at home, tell the team early, because the preferred place of care is part of the plan.
• Keep a short note of who you asked, when and what you were told.
• Remember consent. Information about the person is shared with you only with their explicit consent. If they lack capacity to decide, staff follow the Mental Capacity Act 2005 and may decide in the person's best interests. None of this stops you telling the clinician what you have seen.

What Fast Track does not require

A fixed prognosis

The tool should be supported by a prognosis where one is available, but the framework says strict time limits based on a specified length of life remaining should not be imposed. If you are told that Fast Track only applies once a set number of weeks is left, that does not match the framework. The tool can also be used early: where a person shows few symptoms now but rapid deterioration is clearly expected soon, it can be used in anticipation, agreeing who will do what when needs arise or planning an early review.

Any setting, including going home

Fast Track can be used in any setting, including the person's own home, a care home where they wish to remain and a hospice. The person does not have to move first. If someone wants to be cared for at home at the end of their life, the framework's aim is that they receive the support they need in their preferred place as soon as reasonably practicable, without going through the full eligibility process.

Having no care in place yet

If the person meets the criteria, the tool should be completed even when a care package is already in place, unless the NHS already funds that package in full. The person may be paying for their own care, or the local authority may be funding or charging for care that the NHS should now fund.

What the ICB must do when it receives the tool

An ICB must accept and immediately action a properly completed tool. The framework says it should respond promptly and positively, act urgently to agree and commission the care package and make sure enough capacity exists to keep delays minimal. Because of the nature of the needs, the time to arrange the package should not usually exceed 48 hours from receipt.

That 48 hours is an expectation in national guidance, not a legal guarantee. In practice it depends on the ICB arranging a provider. If care has not started, it is reasonable to ask the clinician or the ICB's CHC team what is outstanding. The ICB must also notify its decision in writing with reasons, and the clinician should provide a care plan covering immediate needs and the person's preferences, either with the form or as soon as practicable afterwards.

If the ICB has questions about the form

Exceptionally, a completed tool may appear unrelated to the criteria. The framework's example is a form describing mental health needs and challenging behaviour with no mention of a rapidly deteriorating condition that may be entering a terminal phase. The ICB should then urgently ask the clinician to clarify, and if the tool turns out not to have been appropriate, the clinician is asked to submit a Checklist. The framework is explicit that a person should not wait for their care package while such concerns are resolved.

What the clinician should explain

The clinician should explain the process sensitively to the person and, where appropriate, their representative, take their views into account and make every reasonable effort to involve them at each stage. Two points should be made clear: needs and care arrangements will be reviewed, and a change in needs could lead to a review of eligibility, which might change the funding.

Questions worth asking the clinician:

• What are the reasons you think the Fast Track criteria are met?
• When will the form reach the ICB, and who will contact us about the care?
• What happens if care has not started within two days?
• When is the first review likely to be, and who will do it?

Reviews and the end of life

Fast Track settles funding quickly, but it does not mean nothing is looked at again. The framework says it is important to review the person's care needs and how well the arrangements are working, and in some situations that may include reviewing CHC eligibility. ICBs should make such decisions in Fast Track cases with sensitivity. The framework sets out several protections:

• Where a person is expected to die in the very near future, the ICB should continue to take responsibility for the care package until the end of their life.
• Where the person is clearly still rapidly deteriorating and the original decision was appropriate, a review of eligibility is unlikely to be needed.
• Funding should not be removed unless eligibility has been reconsidered through a Decision Support Tool completed by a multidisciplinary team, which makes a recommendation.
• Any proposed change in funding responsibility should be notified to the person in writing, with details of their right to request a review, in a sensitive, timely and person-centred way.

If your family is ever told funding will change, ask for the reasons in writing and ask whether a multidisciplinary team has completed the Decision Support Tool. If you disagree with a decision, local resolution and independent review apply.

Is Fast Track the only NHS end of life care funding route?

No. The framework says not everyone at the end of their life will be eligible for, or need, CHC, that local systems run several end of life pathways and that Fast Track is not the only way to qualify towards the end of life. The Decision Support Tool asks practitioners to record observed and likely deterioration, so it can count on the standard route. The framework adds that this should not be used as a way round the Fast Track tool when a person meets its criteria.

A person in a nursing home who is not eligible for CHC may still receive a different payment. See NHS-funded nursing care vs CHC.

Fast Track in numbers

Fast Track assessments outnumbered standard ones by more than two to one, and NHS England's data records every completed Fast Track assessment as eligible. The assessment figures count work across a year and the others count people on one date, so they should not be compared directly. Free independent advice is available from Beacon on 0345 548 0300, as listed on the NHS website.

Common questions