Individuals with a rapidly deteriorating condition who may be entering a terminal phase may require ‘fast-tracking’ for immediate provision of NHS continuing health care (CHC). 

The intention of the fast-track pathway is that it should identify individuals who need to access NHS continuing healthcare quickly with: 

  • minimum delay 

  • no requirement to complete the checklist or the decision support tool (DST)

Therefore, the completed fast-track pathway tool – which clearly evidences that the person has a primary health need arising from a rapidly deteriorating condition and the condition may be entering a terminal phase – is in itself sufficient to establish eligibility. 

In fast-track cases, the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 (‘the standing rules’) state that it is an “appropriate clinician” who determines that the individual has a primary health need. The ICB must therefore determine that the individual is eligible for NHS continuing healthcare, and should respond promptly and positively to ensure that the appropriate funding and care arrangements are in place without delay. 

An ‘appropriate clinician’ is defined as a person who is: 

a) responsible for the diagnosis, treatment or care of the individual under the 2006 Act the National Health Service (Consequential Provisions) Act 2006 in respect of whom a fast-track pathway tool is being completed; and 

b) a registered nurse or a registered medical practitioner. 

The fast-track pathway tool must only be used when the individual has a rapidly deteriorating condition and may be entering a terminal phase. 

The fast-track pathway tool replaces the need for the checklist and the DST to be completed. However, a fast-track pathway tool can also be completed after the checklist if it becomes apparent at that point that the fast-track criteria are met. 

The fast-track pathway tool can be used in any setting. This includes where such support is required for individuals who are already in their own home or are in a care home and wish to remain there. It could also be used in other settings, such as hospices. 

The completed fast-track pathway tool should be supported by a prognosis, where available. However, strict time limits that base eligibility on a specified expected length of life remaining should not be imposed: 

a) ‘rapidly deteriorating’ should not be interpreted narrowly as only meaning an anticipated specific or short time frame of life remaining 

b) ‘may be entering a terminal phase’ is not intended to be restrictive to only those situations where death is imminent 

Further resources: 

Fast-track pathway tool for NHS continuing healthcare guidance - GOV.UK (www.gov.uk)