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Purpose of the Fast Track Pathway
The Fast Track Pathway is intended for people whose health is deteriorating rapidly and where there is a real concern that they may be entering a terminal phase of illness. Its purpose is to ensure that care is put in place without delay, at a point when further assessment would be inappropriate and potentially distressing. Unlike the standard NHS Continuing Healthcare process, the Fast Track Pathway does not require completion of a Checklist or a Decision Support Tool. Where the criteria are met, a completed Fast Track Pathway Tool is sufficient in itself to establish eligibility for fully NHS-funded care. The emphasis is on speed, compassion and proportionality, recognising that time is often limited and that families should not be required to navigate a lengthy assessment process at the end of life. The Role of the Appropriate Clinician The decision that an individual meets the Fast Track criteria must be made by an “appropriate clinician”. This is defined in the National Framework as a registered nurse or registered medical practitioner who is directly responsible for the individual’s diagnosis, treatment or care under the National Health Service Act 2006, and who has sufficient knowledge of the person’s condition to explain why the criteria are met. In practice, this may be a GP, hospital consultant, community nurse or a specialist palliative care clinician. Clinicians working in hospices or voluntary organisations can also act as appropriate clinicians, provided they are delivering services pursuant to the 2006 Act. What matters is not the setting, but that the clinician knows the individual and can provide a clear clinical rationale. Integrated Care Boards do not complete Fast Track referrals themselves. Their role is to respond promptly once a valid Fast Track Pathway Tool has been completed and submitted. Difficulties often arise where responsibility for completing the tool is unclear or where clinicians are reluctant to take ownership, rather than because the criteria are not met. Recognising Deterioration and End-of-Life Indicators The Fast Track Pathway must only be used where a person has a rapidly deteriorating condition and may be entering a terminal phase. These terms are sometimes misunderstood and applied too narrowly. The National Framework is clear that neither concept is restricted to situations where death is imminent, nor should eligibility be based on predicted life expectancy. A person may have periods of apparent stability, yet the underlying condition and overall trajectory make it clear that significant deterioration is expected in the near future. In such circumstances, Fast Track may be appropriate in anticipation of those needs, to avoid repeated assessments and unnecessary upheaval later on. In practice, families and care providers often recognise deterioration before it is formally acknowledged. Where there is concern that end-of-life needs are emerging, it is appropriate to ask for a clinical review rather than waiting for a crisis. The Gold Standards Framework and Proactive Identification Although not a formal requirement of the Fast Track Pathway, clinical tools such as the Gold Standards Framework and its Proactive Identification Guidance (PIG) are often used in practice to support recognition of end-of-life care needs. Where appropriate, a change to “red” status under the Gold Standards Framework can help to confirm that a person is entering the end-of-life phase and underline the urgency of care planning. While the absence of GSF or PIG documentation must not be used as a reason to refuse Fast Track consideration, their use can provide helpful clinical context and assist professionals who are unfamiliar with the individual’s wider trajectory. For families who are being told that “nothing can be done yet”, requesting a review using these frameworks can be an important step in prompting appropriate clinical action. Completion of the Fast Track Pathway Tool Only an appropriate clinician can complete the Fast Track Pathway Tool, but anyone involved in supporting the individual — including family members, care home staff or wider members of the care team — can raise the need for it to be considered. The tool itself is brief. It requires the clinician to explain, based on their knowledge and evidence, why the person has a rapidly deteriorating condition and why that condition may be entering a terminal phase. A prognosis may be included where available, but strict time limits must not be imposed and eligibility must not be tied to predicted length of life. The completed tool should be supported by a care plan describing the individual’s immediate needs and preferences, so that appropriate care can be commissioned without delay. You can view the Fast Track Pathway Tool here: |
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Existing Care Arrangements
The presence of an existing care package does not prevent use of the Fast Track Pathway. Where the criteria are met, the tool should be completed even if the individual is self-funding care or receiving local authority support. The purpose of Fast Track is to ensure that NHS funding replaces arrangements that are no longer appropriate once a primary health need has arisen. Continuing to self-fund, or to rely on local authority funding, in these circumstances is not consistent with the National Framework. Preferences, Place of Care and Sensitivity A central aim of the Fast Track Pathway is to support people to receive care in their preferred place, wherever reasonably possible. This may be their own home, a care home or another setting that better reflects their needs at the end of life. The process should always be explained carefully and sensitively to the individual and, where appropriate, to their family or representatives. People should understand what Fast Track funding means, how care will be arranged, and that eligibility may be reviewed if circumstances change. Any such review must be approached with particular care, as sudden changes to funding arrangements can be deeply distressing at the end of life. How ARROW Supports Families In my work, I am often contacted at the point where deterioration is clear but the Fast Track Pathway has not been initiated, or where families are being told that no one is able to help. This is rarely because the criteria are not met. More often, it reflects uncertainty about responsibility, reluctance to act, or a lack of coordination between services. ARROW supports families by helping them to understand when Fast Track should be considered, ensuring that the right clinician is engaged, and supporting communication between care providers and the Integrated Care Board so that care is put in place without avoidable delay. The focus is always on reducing stress for families and ensuring that the system responds as it is intended to do at the end of life. If you are supporting someone whose health is deteriorating and you are unsure whether the Fast Track Pathway should be considered, it can be helpful to talk this through with someone who understands both the clinical and procedural landscape. ARROW offers confidential, practical guidance at this stage, helping families and professionals to understand their options and to navigate the process with clarity and sensitivity. You are welcome to get in touch for an initial conversation if that would be helpful. |
