FAST TRACK

The Fast Track process is used to enable the immediate provision of NHS Continuing Healthcare and is only applicable to those situations where the individual has a 'rapidly deteriorating condition that may be entering a terminal phase'. 

The Fast Track Pathway Tool must not be used unless these criteria are met

It is not intended as a way of avoiding the NHS CHC eligibility assessment process except in situations where rapid deterioration is evident, and it is expected that the individual may be entering a terminal phase.

 An individual may, currently, be demonstrating few symptoms, yet the nature of their condition is such that it is clear that rapid deterioration is to be expected in the near future. It may therefore be appropriate to use the Fast Track Pathway Tool in anticipation of those needs arising. 

The National Framework for NHS Continuing Healthcare and NHS funded Nursing Care (Revised 2018) states, 'the intention of NHS CHC Fast Track is to identify individuals needing to access CHC quickly with no requirement to complete a Decision Support Tool (DST)'. 

It is intended to provide expert and dedicated end of life support for people whose condition is rapidly deteriorating and may be entering a terminal phase. 

When an appropriate clinician completes the Fast Track tool stating why the individual meets the criteria it is sufficient to establish eligibility and the Clinical Commissioning Group (CCG)/Integrated Care Board (ICB) must respond promptly and positively.

BEST PRACTICE 

Identifying need

Others involved in supporting those with end of life needs may identify the fact that the individual has needs for which use of the Fast Track Pathway Tool would be appropriate.

They should contact the appropriate clinician who is responsible for the diagnosis, care or treatment of the individual and ask for consideration to be given to completion of the Fast Track Pathway Tool. 

Consent 

Before assessing with a Fast Track Pathway tool, it is important to consider the need for consent. Consent is not required to undertake a Fast Track pathway tool (unless sharing of information with third parties including family is involved) but it is good practice to seek consent for sharing information with third parties at this point.

In the event that the individual is unable to provide this consent then a 'best interests' decision in accordance with the Mental Capacity Act 2005 should be undertaken.

Explaining the process to the individual

Clinicians completing the Fast Track Pathway Tool should sensitively explain the process to the individual (and/or their representative) and make them aware that their needs will be subject to review to ensure the effectiveness of the care arrangements. In certain situations, it may be appropriate to review care needs and subsequent eligibility for NHS CHC which could mean the funding stream may change subject to the outcome of this review. 

Use of the Fast Track Pathway Tool

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.

If an individual meets the criteria for the use of the Fast Track Pathway Tool then the Tool should be completed even if an individual is already receiving a care package (other than one already fully funded by the NHS) which could still meet their needs. This is important because the individual may at present be funding their own care or the local authority may be funding (and/or charging) when the NHS should now be funding the care in full. 

Key points 

• The Fast Track Pathway Tool must only be used where an individual has a rapidly deteriorating condition which may be entering a terminal phase - it is not to be used in any other circumstances

• The CCG/ICB must accept and action the Fast Track Pathway Tool immediately where the Tool has been properly completed in accordance with the criteria for the use of the Tool as explained above

• A Continuing Healthcare Checklist and Decision Support Tool are not required when a Fast Track application is made