Fast-track CHC.

What it is

The standard NHS Continuing Healthcare assessment process can take weeks. For people who do not have weeks, the National Framework includes a fast-track pathway. A senior clinician completes a short document called the Fast Track Pathway Tool. The ICB is then required to put funding in place “urgently”, typically within 48 hours of receiving the form.

Fast-track is not a different test of eligibility for free care. It is a different process for people whose situation rules out the standard process simply because they may not be alive when it concludes.

The eligibility test

A person can be considered for fast-track if they have:

• A rapidly deteriorating condition, and
• The condition may be entering a terminal phase

“Rapidly deteriorating” and “may be entering a terminal phase” are deliberately broad. The National Framework does not require certainty about life expectancy. The intent is to capture anyone who clearly should not have to wait for a full assessment because their state is changing too quickly.

In practice the threshold is usually understood as a prognosis of weeks to a few months. Six months is often cited as an upper boundary but is not a fixed rule. A clinician making a fast-track application is asserting in their professional judgement that the standard route would be inappropriate.

Who can apply

Only an appropriate clinician can complete the Fast Track Pathway Tool. The National Framework lists the people who can sign:

• A registered nurse who has the skills and knowledge appropriate to the person’s needs
• A registered medical practitioner, normally a GP, hospital consultant or specialty doctor
• Other registered health professionals where they have suitable knowledge of the condition

Families and care home staff cannot complete the form themselves but can and should ask the relevant clinician to do so. Hospice teams, palliative care specialists, district nurses, oncology specialists and GPs are the most common signatories.

What it pays for

Fast-track CHC funds the same care package as standard CHC. The full cost of an appropriate placement, the nursing input, the personal care, equipment, medication and continence products. The package can be at home, in a hospice, or in a care home.

The placement is commissioned to match the assessed needs. If the family prefers a more expensive care home than the ICB has agreed to, the difference is a top-up paid by the family.

The 48-hour timeline

The National Framework expects the ICB to put funding in place urgently, normally within 48 hours of receiving a properly completed Fast Track Pathway Tool. Some ICBs perform better than this. A few do not meet the target.

If funding is delayed and family is paying for care in the meantime, the National Framework requires the ICB to backdate the funding to the date the Fast Track Pathway Tool was completed. This is a recoverable cost. The family can claim reimbursement for the period between completion of the form and the ICB’s decision being implemented.

Where a person dies after the fast-track form is completed but before funding has been put in place, the principle is the same. The estate can claim for the costs incurred from the form-completion date.

Reviews

Fast-track funding is not permanent. The National Framework requires a review of the person’s circumstances around three months after the fast-track decision, then at intervals appropriate to the condition. If the person stabilises and is no longer in a rapidly deteriorating state, the funding may transition to standard CHC if they continue to meet that test, or be withdrawn if they do not.

In practice many people who receive fast-track do not survive long enough to be reviewed. Where they do, the review is sensitive and a strong family advocate or independent CHC adviser is worth having.

If a clinician declines to apply

A common difficulty: the family believes their relative is fast-track-eligible but the clinician will not complete the form. The reasons given vary. Some clinicians are not familiar with the process. Some are reluctant to make a prognosis they are not certain about. Some defer to the ICB’s view rather than exercising their own clinical judgement.

What can help:

• Ask the GP, hospital consultant, hospice team and district nursing service separately. Any one of them can complete the form.
• Ask for the reasons in writing. This sometimes prompts reconsideration.
• Contact the local ICB’s CHC team and ask for guidance on which professional should be approached.
• Free independent advice from Beacon CHC can give a clear view on whether the case is fast-track-eligible.

Where this fits with hospice care

Hospice care is a slightly different funding structure. Hospices are mostly charitable and provide their services free. Where someone in a hospice meets the fast-track criteria, the ICB is still responsible for the costs of the care package, which the hospice may invoice or absorb depending on the relationship. Hospice teams are usually skilled at managing the funding interface.