Not many people know that they can avoid delays and shortcut the standard NHS Continuing Healthcare Funding (CHC) assessment process by applying for immediate NHS funding using the Fast Track Process.
Blog updated 23/03/23: Information fact checked. Links to National Framework updated. Links to supporting articles updated.
Fast Track funding is available if your relative meets the eligibility criteria i.e., has “a primary health need arising from a rapidly deteriorating condition and where that condition may be entering a terminal phase.” In that scenario, a fully-funded package of NHS care should be put in place within 48 hours of assessment to meet all their healthcare needs.
However, many families are not even aware that Fast Track funding even exists! This is hardly surprising, as little is overtly publicised by the NHS about its availability. Indeed, many medical professionals we speak to, including GPs, have no real knowledge or understanding of what CHC is, or even how the assessment process works. Yet, they are seeing patients on a daily basis – some of whom may, indisputably, be eligible for Fast Track funding and could missing out on free-funded NHS care at a time when it is most critically needed.
How does the Fast Track assessment process work?
Paragraphs 241 to 269 of the revised National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (July 2022) provide helpful guidance and support regarding Fast Track assessments.
A Fast Track assessment is carried out using the Fast Track Pathway Tool (revised July 2022) designed to anticipate future needs.
The Fast Track Pathway Tool is an abbreviated form, which records the individual’s condition (assessment, diagnosis & prognosis), their immediate and future needs and details of any deterioration (present and anticipated) with timescales.
The Fast Track Pathway Tool can be used in any care setting. So your relative doesn’t have to be in a care home.
Who can carry out the Fast Track assessment?
The Fast Track Pathway Tool will be completed by an ‘appropriate clinician’ to determine whether your relative has a ‘Primary Health Need’. The clinician should be someone who is responsible or knowledgeable about your relative’s health needs, their diagnosis, treatment or care. As such, they are best placed to provide an assessment of their health needs, and can comment on whether they have a rapidly deteriorating condition and may be entering a terminal phase.
An ‘appropriate clinician’ can be a registered nurse or registered medical practitioner, and is usually a Consultant, Registrar or GP. So, these are the people you urgently need to contact and request they complete the Fast Track Pathway Tool. Their clear reasons as to why your relative has a rapidly deteriorating condition and which may be entering a terminal phase, with supporting evidence, should be sufficient to trigger Fast Track Funding without delay. Speed is of the essence!
There are obvious advantages of using the Fast Track Pathway:
- A decision as to eligibility can be reached quickly and by a clinician who actually knows your relative’s needs; who is actively involved in their care; and has first-hand knowledge and experience of their rapidly deteriorating condition.
- It bypasses and replaces the usual lengthier full assessment process; dispenses with both the need to complete an initial Checklist; avoids delays whilst waiting for a full assessment by a Multi-Disciplinary Team and for their outcome to be communicated and then the package of care to be implemented.
What happens next?
The completed Fast Track Pathway Tool is submitted to NHS Integrated Care Board (ICB) together with a care plan (or as soon as available afterwards) in order for the ICB to support the care package.
Once approved, the ICB should communicate the outcome within 48 hours and a care package put in place immediately to meet your relative’s needs, wherever they choose to reside– with obvious beneficial financial and savings in funding care from private means. There should be minimal delay – hence ‘fast track’.
Remember: Even if your relative is already receiving a funded care package (but not through the NHS), it is still worth pushing for a Fast Track Pathway assessment to ascertain whether the NHS should take over funding of the care in full, at this stage.
Make sure you monitor the situation to ensure that the ICB actions the fast track care package promptly!
Common Fast Track Issues to watch out for:
- Your relative doesn’t have to be in a care home to access Fast Track Funding. The setting where care is provided is their entirely their choice. The main priority is to get the funding in place immediately.
- It is often wrongly assumed that you have to be at “death’s door” to seek a Fast Track assessment for CHC Funding. That is incorrect! A rapidly deteriorating condition can of course happen at any stage in life – and not just at a terminal phase.
- Expected length of life remaining is not a consideration that should be taken into account.
- The Integrated Care Board (ICB) cannot not make excuses that Fast Track Funding is too expensive. The cost of care is irrelevant and should not be a consideration.
- Although the Fast Track Pathway is usually seen as an end-of-life tool to assess people in their latter stages of life – that is not necessarily the case. The Fast Track Pathway Tool for NHS Continuing Healthcare (July 2022) can be used for individuals “who need access to NHS Continuing Healthcare quickly, with minimum delay…”
- Indeed, just because your relative may not be showing visible signs of significant clinical symptoms now, the nature of their condition and expected inevitable rapid deterioration in the future (progressing to a terminal phase) can, in itself, justify Fast Tracking. So, early planning for the inevitable and putting a contingency plan in place to meet the anticipated needs once they materialise, may help avoid unnecessary or repeat assessments in the future.
- You cannot use the Fast Track process to circumvent (‘cheat’) the CHC system. The Fast Track Pathway has to be used for genuine purposes. So, unless your relative meets the eligibility criteria i.e., has a rapidly deteriorating condition that may be entering a terminal phase, the Fast Track Pathway is not applicable. Instead, the ordinary Checklist assessment process should be used.
- Where your relative already has a care package in place that is not provided by the NHS, e.g,, it is funded by their local authority, a Fast Track Pathway assessment may still be required as Fast Track funding should be the responsibility of the NHS.
Reviews
The ICB will usually undertake a review of the awarded Fast Track care package after 3 months to check that it is still needed and effectively meeting the individual’s needs. The NHS National Framework stipulates that those with a short life expectancy, should be funded until the end of their life.
If it is apparent that the original decision to award Fast Track funding is still appropriate, then the ICB may take the view that a review is unnecessary and continue to provide the existing CHC funded package.
Some reviews may inadvertently slip through the net and individuals may remain CHC funding indefinitely until the ICB realise their error or until the family applies for review as the current package of care is now inadequate to meet their relative’s increasing and more challenging needs.
Beware! Fast Track Funding should not be removed arbitrarily, i.e., without first undertaking a full review of the individual’s eligibility for CHC by a Multi-Disciplinary Team (MDT).
Of course, the worry of having a review pending can cause huge anxiety, as there is always the risk that it could trigger an MDT where it is decided that CHC Funding should be withdrawn.
In summary:
Request a Fast Track Pathway assessment without delay if you believe your relative is eligible for Fast Track funding.
Critically, some individuals with a rapidly deteriorating condition, could mistakenly be shunted down the longer full assessment route, and miss out on vital CHC Funding, at a crucial time when it is needed most!
If you need help or guidance, contact us or visit our Nurse Advice Line for practical help from a specialist CHC Nurse.
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My mother has had to have 24 hour live in care for a number of years and we have had one failed CHC. She has just been discharged from hospital and has received a Fast Track result and they are putting in place 3 half hour calls per day. My question is shouldn’t they now be paying for the 24 he care that mum now requires. We are still having to provide the 24 hour care. If I disagree with the 3 daily calls do I have to start all over again? Any help would be appreciated.
Glynis, Moira, Sara, your experiences echo my experiences with my Dad last year. NHS staff we spoke to were entirely ignorant of the existence of Fast Track, apart from two consultants. One said that he had to have a terminal illness and less than six weeks to live. The other simply refused to use Fast Track and said if we wanted CHC Dad would have to stay in hospital for 28 days and go through a full MDT assessment. We fought the hospital to take him home. He had deteriorated terribly since he was admitted. A GP visited him and told us she believed he was end of life. She said she would Fast Track him. We waited four days and nothing happened. Fast Track it turned out simply meant having access to the 24 hour district nurse service to request end of life medications. I insisted that Fast Track CHC was put in place(no doctor at the GP practice knew about it) and hastily a nurse who had never met my Dad completed and submitted paperwork. Still nothing happened and I had to phone the CCG. The CCG had no idea how to commission the care needed and the agency they chose was not really suitable. It felt as though the CCG had never before had to find suitable care for someone dying at home. Given the experiences described on this site I suspect Fast Track is hardly ever used when it clearly should be. The lack of humanity is staggering. The elderly, whether in need of long-term healthcare or quite literally dying in front of NHS staff, are just not a priority.
It’s an utter disgrace Meggie. PLEASE can I urge you to email Victoria Macdonald at Channel 4 news. She has already run 1 story on this earlier in the year on channel 4 news when I messaged her about our case. The more that can contact her, the more it will bring it to the attention of the public. Her email address is victoria.macdonald@itn.co.uk
Why, why oh why are we not informed about The Fast Track Pathway Tool. It is because the powers that be want us all to pay for are own care! My husband rotted away in a Nursing Home in 2022 because no one cared. He was awarded two As, upon discharge from the hospital but someone, unbeknown to me downgraded his scores, thus making him ineligible for 24/7 CHC. He was 100% disabled but he could see, speak & swallow. When applying for CHC, the questions need to be changed because they are fair. The UK National Framework is based upon the Coughlan/Grogan cases. Although Mrs Coughlan was100% disabled she could at least use a wheelchair, unlike my husband, who could not. Mrs Grogan had many medical problems plus odema causing an excess build up of fluid in her body. My husband had heart problems & odema causing an excess build up of fluid. He weighed 26 stone at his heaviest. He also had Type 2 Diabetes with diabetic neuropathy in his hands and feet, which also scores an A, a well kept secret in the UK! No one cared if we couldn’t afford the care. The powers that be will not be getting half of the house to pay for the care, which I have refused to pay for over the last two years. I have made sure of that. In the end he took his own life by he refusing his medication because he was in so much pain. I did take some very disturbing pictures and have sent them to many people in power and all they say is that they are sorry. Nothing has been done to help me. PHSO, LHO, Health Watch & I am now awaiting the outcome from PohWER.
My MIL was in hospital in August, we knew she was dying – severe (very rapid) dementia, not able to swallow, unable to move etc). On the 30th August the doctor finally admitted they could do nothing more and asked where she was to go (to die). They made it clear she should not be in hospital as they could not do anything – I’d been telling them this for about 2 weeks. I immediately asked for fast-track CHC having been through the normal procedures with my own mother. They said ok, they’d sort it out. She died on the Saturday (1st Sept) without ever being assessed or us managing to get her home (which was what she wanted). What should have happened? Should that doctor have done the assessment there and then? Does the 48 hours rule include weekends? I cannot see them managing to sort out care in 48 hours and get her home.
We asked for a fast track assessment as it was obvious that the person was entering a terminal phase, unable to swallow either food, liquidised food or water, as a result of Parkinson’s. The person from CCG said he wasn’t going to die within 3 months so wasn’t eligible. Disgraceful. Just money saving.
He went on end of life care 2 days later and dies 6 days after that. He did get CHC for final 7 days.
My mother-in-law was discharged from hospital as “end of life” in June last year. She died in March this year & needed 24 hour round the clock nursing & care needs. We also have a GP letter to support this. However she was deemed as not being eligible for CHC funding. She was never fast-tracked as we didn’t find out she was end of life until we received hospital notes just after her death. Although the CHC would have been aware of this diagnosis. The new National Framework guidelines state that patients diagnosed as end of life, are now virtually automatically eligible for funding. We have argued this point with both the LAP & IRP, but because she passed away before the new guidelines, they have refused it. It’s complete & utter madness……