Fast Track Pathway for NHS Continuing Healthcare

Purpose of the Fast Track Pathway

The Fast Track Pathway is designed for individuals with a rapidly deteriorating condition that may be entering a terminal phase. It ensures they receive immediate access to NHS Continuing Healthcare with minimal delay and without the need to complete a Decision Support Tool (DST). A completed Fast Track Pathway Tool, with clear evidence of the individual’s condition, is sufficient to establish eligibility.

Role of the ‘Appropriate Clinician’

The decision that an individual has a primary health need and qualifies for NHS Continuing Healthcare is made by an ‘appropriate clinician’. This is defined as a registered nurse or medical practitioner responsible for the individual’s diagnosis, treatment, or care under the National Health Service Act 2006. They must be familiar with the individual’s condition and able to explain why the Fast Track criteria are met. Clinicians from voluntary or independent organisations, such as hospices, can also act as appropriate clinicians if they are delivering services under the 2006 Act.

Supporting End-of-Life Needs

While others involved in supporting end-of-life care cannot complete the Fast Track Pathway Tool, they may highlight the need for it to the appropriate clinician. The clinician must then assess whether the Fast Track criteria are met.

Completing the Fast Track Pathway Tool
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The Fast Track Pathway Tool is only used when an individual has a rapidly deteriorating condition that may be entering a terminal phase. It replaces the need for a Checklist and DST but can be completed after a Checklist if the criteria become evident. The tool applies in all settings, including homes or care facilities, where immediate support is required.

The tool should be supported by a prognosis, though strict time limits or expectations about life expectancy should not be imposed. Terms like ‘rapidly deteriorating’ and ‘may be entering a terminal phase’ are not restricted to short-term or imminent end-of-life scenarios.

Decision-Making Responsibility

It is the appropriate clinician’s responsibility to decide whether an individual meets the Fast Track criteria. They should explain the process to the individual and clarify that their needs may later be reviewed, which could impact funding arrangements. If the condition is expected to deteriorate soon, the tool may be completed in anticipation of those needs to prevent unnecessary assessments later.

Additional Considerations

The Fast Track Pathway Tool is not the only method for qualifying for NHS Continuing Healthcare at the end of life. The DST also documents deterioration and can determine eligibility. However, the DST should not replace the Fast Track Pathway Tool when the criteria for the latter are met.

When completing the tool, clinicians should provide an overview of the individual’s current condition, anticipated progression, and any discussions with the individual or family about their care and prognosis. This information is helpful but not a prerequisite for eligibility.

Addressing Existing Care Arrangements

Even if an individual already has a care package in place (e.g., self-funded or local authority-funded), the Fast Track Pathway Tool should still be completed if they meet the criteria. This ensures NHS funding replaces inappropriate self-funding or local authority charges.

Individual Preferences and End-of-Life Care

The Fast Track Pathway aims to honour the individual’s preferences for where they receive care during the end-of-life stage, whether at home or elsewhere. The goal is to ensure they receive appropriate support promptly in their preferred setting, bypassing the full NHS Continuing Healthcare eligibility process where possible.

Sensitivity and Communication
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The Fast Track process must be explained carefully and sensitively to the individual and their representatives. Decisions should be made thoughtfully to minimise any distress caused by sudden changes to NHS Continuing Healthcare eligibility.