The CHC fast track, explained

What is the CHC fast track?

NHS Continuing Healthcare is the NHS funding for adults whose main need for care is a health need. When someone is eligible, the NHS arranges and funds the whole care package. Our guide to what NHS Continuing Healthcare is explains the funding itself. This page is about the fastest way into it.

The standard route has two assessment stages before any funding decision: a screening called the CHC Checklist, then a full assessment using the Decision Support Tool. The fast track exists because some people do not have time for that. The National Framework sets out exactly when it applies:

"For those with a primary health need arising from a rapidly deteriorating condition, and where that condition may be entering a terminal phase, a Fast Track Pathway Tool should be completed."

National Framework, page 35

The phrase "terminal phase" is hard to read about someone you love, and we will not soften it into something vaguer, because it is the legal wording that opens this route. It means the clinicians caring for the person believe they may be approaching the end of their life. The word "may" is doing real work in that sentence. Nobody has to be certain, and nobody has to name a date.

When the fast track applies, it does not shorten the standard assessments. It removes them. The Fast Track Pathway Tool "replaces the need for a Checklist and DST to be completed" (National Framework, page 77). One tool, completed by a clinician, takes the person straight to funded care.

Who qualifies for fast track?

The test is the sentence quoted above, and it has two parts. First, the person has a rapidly deteriorating condition. Second, that condition may be entering a terminal phase. Both parts are a matter of clinical judgement about how the person is now, and how quickly things are changing.

Two things are deliberately absent from that test. There is no list of qualifying illnesses, because for CHC generally "the diagnosis of a particular disease or condition is not in itself a determinant of eligibility" (National Framework, page 24). And there is no requirement for a prognosis. The Framework says an ICB "should not require" information about the likely progression of the condition "as a prerequisite for establishing entitlement" (National Framework, page 78).

That second point matters in practice. Families are sometimes told the fast track needs a confirmed life expectancy, of weeks or of months, before it can be used. The Framework does not say that. If anyone asks you for a prognosis as a condition of starting the fast track, you can point to page 78.

Who fills in the Fast Track Pathway Tool?

An "appropriate clinician" completes the Tool: a registered nurse or registered medical practitioner responsible for the person's diagnosis, treatment or care (National Framework, pages 76 to 77). That will usually be the hospital doctor, the GP, or a nurse from the team looking after them, and clinicians in hospices with a specialist end of life role can also qualify. Families do not complete the Tool themselves. In fast track cases it is the clinician who determines the primary health need, and the ICB must then decide the person is eligible (National Framework, page 76).

What a family can do is ask. If your relative is getting worse quickly, ask the clinicians caring for them, directly and by name if you can, whether a Fast Track Pathway Tool should be completed. Many families have never heard of the fast track until someone mentions it, and the professionals around a busy ward or surgery do not always raise it first. Asking the question is often the step that starts everything else.

Once a clinician has properly completed the Tool and sent it to the ICB, the integrated care board that funds NHS care in your area, the duties described in the next section take over. Your job at that point is done. Nothing further is needed from the family for the funding decision itself.

How fast is fast track?

This is where the fast track differs from everything else in the CHC process. Most CHC timescales are expectations, written with words like "should" and "usually". The duty on the ICB when a completed Tool arrives is not one of them:

"In order to comply with Standing Rules an ICB must accept and immediately action a Fast Track Pathway Tool where the Tool has been properly completed."

National Framework, page 79

"Must" is the strongest word the Framework uses. The ICB cannot queue a properly completed Tool, reassess it, or ask for the standard process to be followed instead. It must accept it and act on it immediately.

The speed of the care itself is then set as an expectation. The Framework says action should be taken urgently to agree and commission the care package, and that "this time period should not usually exceed 48 hours from receipt of the completed Fast Track Pathway Tool" (National Framework, page 79). Note the exact words: "should not usually exceed". That is a strong expectation rather than an absolute rule, and an ICB that goes beyond it should be able to explain why.

For comparison, the standard route from a positive Checklist to an eligibility decision should not exceed 28 calendar days in most cases (National Framework, page 55). The fast track compresses a process measured in weeks into one measured in hours.

What if care is already in place?

Some families assume the fast track is only for people with no care arranged. The Framework says the opposite. The Tool should be completed even if a care package is already in place, because the person, or the local authority, may currently be paying for care that "the NHS should now be funding" in full (National Framework, page 78).

So a person already settled in a care home, or already supported at home by paid carers, can still be fast tracked. What changes is who pays. If the person has been funding their own care, that stops. If your relative is in a care home with nursing and the NHS pays NHS-funded Nursing Care, a set contribution towards the cost of registered nursing, that is the smaller award. CHC through the fast track covers the whole package, and the person should be considered for CHC before any decision about the nursing contribution (National Framework, page 9).

The practical point for families: do not hold back from asking about the fast track because care is already sorted. The Framework tells clinicians to complete the Tool anyway.

What happens afterwards?

A person found eligible through the fast track gets NHS Continuing Healthcare itself: "a complete package of ongoing care arranged and funded solely by the NHS" (National Framework glossary, page 167). The NHS arranges the care as well as paying for it, which lifts the organising burden from the family at the point it is heaviest.

The care can be provided wherever the person is or wants to be. The Framework says NHS Continuing Healthcare "may be provided in any setting (including, but not limited to, a care home, hospice or the person's own home)" (National Framework, page 24). Eligibility is not affected by the setting or by who delivers the care.

Funding that has been put in place is also protected from sudden withdrawal. The Framework says neither an ICB nor a local authority should unilaterally withdraw from an existing funding arrangement without a joint reassessment, and without first consulting one another and the individual, and that it is essential that alternative funding arrangements are agreed and put into effect before any withdrawal of existing funding (National Framework, page 62). If anyone suggests the funding will simply stop after a review, that is the rule to point to.

Reviews do happen. After a positive eligibility decision the Framework expects a first review within three months, and further reviews at least annually (National Framework, page 61). A review looks at whether needs have changed. For a person on the fast track, the well-managed needs rule still applies: care that is working does not make the needs behind it disappear.