NHS Continuing Healthcare Fast Track

The NHS Continuing Healthcare (CHC) Fast Track pathway is an urgent assessment route within the broader CHC framework, designed for people whose clinical condition is rapidly deteriorating and who may be entering a terminal phase of a life-limiting illness. Where the standard CHC process involves a full Multi-Disciplinary Team (MDT) assessment that can take weeks, the Fast Track pathway can result in fully funded care being arranged within 48 hours of the form being submitted.

CHC Fast Track funding is fully funded by the NHS and is not means-tested. A person receiving Fast Track CHC does not pay for their personal care regardless of their savings, income, or property. This makes it one of the most significant sources of care funding available in England — a person who might otherwise be facing tens of thousands of pounds in care home fees receives full NHS funding instead.

The Fast Track pathway is separate from the standard CHC Checklist and Decision Support Tool process. It does not replace full CHC — a person who stabilises after being funded under Fast Track may later be reviewed under the standard CHC process to determine whether they continue to meet the full CHC eligibility criteria. If they no longer meet the Fast Track criteria but potentially meet standard CHC criteria, a full assessment should follow.

Integrated Care Boards (ICBs) — the NHS commissioning bodies in England — are responsible for CHC funding decisions and for arranging care under the Fast Track. The individual does not apply directly; a clinician initiates the process by completing the Fast Track tool.

The Fast Track pathway is initiated by a clinician completing the NHS Fast Track tool form. The clinician must be a registered healthcare professional — this includes:

• Doctors (GPs, hospital consultants, palliative care physicians)
• Registered nurses (including clinical nurse specialists, community nurses, Macmillan nurses)
• Occupational therapists, physiotherapists, and other AHPs in some circumstances
• Social workers are not eligible to complete the Fast Track form — it must be a registered healthcare professional

The clinician must be able to certify that the person has a rapidly deteriorating condition that may be entering a terminal phase, and that delaying care planning would be inappropriate given the prognosis. The form asks the clinician to describe the nature of the condition, the trajectory of deterioration, and why standard CHC assessment processes would be inappropriate given the urgency.

If you believe a family member or someone you care for is in a terminal or rapidly deteriorating phase and is not receiving appropriate care, you can request that their GP, Macmillan nurse, or palliative care team consider completing a Fast Track form. You do not have to wait for the clinical team to initiate the process — you can ask directly. It is also reasonable to ask the hospital discharge team to explore Fast Track CHC if someone is being discharged in a terminal or rapidly deteriorating condition.

Once a completed Fast Track form is submitted to the Integrated Care Board (or its delegated CHC team), the ICB must make a decision and arrange care within 48 hours. This is a strict timescale, and failure to comply can be the subject of a complaint and NHS ombudsman review. The ICB should not delay because it has not yet identified a specific care provider — it must begin the process immediately.

The Fast Track decision is made by a senior clinical professional within the ICB (or its delegate). They review the form and, if satisfied that the criteria are met, approve CHC funding and begin arranging care. In practice, most Fast Track applications submitted by a suitably qualified clinician with a completed form are approved promptly.

Care under the Fast Track pathway can be arranged in various settings depending on the person's wishes, their clinical needs, and what is available:

• At home: Care at home funded by the NHS, including nursing visits, personal care, and end-of-life care support. The NHS arranges the care package through community nursing and commissioned care providers.
• Care home: Funded placement in a care home (including a nursing home if nursing care is needed). The NHS pays the full care home fee — the individual does not contribute.
• Hospice: Referral to and funded placement in a hospice, either as an inpatient or for day services, if this is clinically appropriate and the person's choice.

The person's wishes about where they want to receive care should be central to the care planning discussion. The ICB should take all reasonable steps to honour a preference for care at home if this is safe and achievable with the available care package.

NHS CHC — including Fast Track CHC — is entirely free to the recipient. There is no means test, no contribution from savings or property, and no requirement to sell assets to fund care. This is because CHC is an NHS health service, and NHS services are free at the point of use for those who qualify on clinical grounds. It is this characteristic that distinguishes CHC from local authority social care funding, which is means-tested.

CHC Fast Track funding covers:

• All personal care costs (washing, dressing, continence care, medication administration)
• All nursing care costs (wound management, specialist clinical monitoring, medical equipment)
• In a care home: the full care home fee including the accommodation element (unlike standard CHC, where there is debate about the accommodation cost split in some cases)
• Community nursing and specialist nurse visits at home
• Equipment required for care at home (hospital bed, hoist, pressure-relieving mattress, etc.)

If a family has been funding care privately and a Fast Track CHC application is then approved, the NHS takes over the funding from the date of the Fast Track approval. Costs paid privately before the approval are not automatically reimbursed — though in cases where a full CHC assessment should have been triggered earlier and was not, there may be grounds to request a retrospective review of the funding decision.

Family carers and representatives should keep a record of any care costs paid privately during a period when CHC may have been applicable, in case a retrospective review is pursued. Specialist CHC solicitors or advisers (many operate on a no-win no-fee basis for retrospective CHC claims) can advise on the merits of such a claim.