Guidance

Fast track pathway tool for NHS continuing healthcare - guidance

Updated 20 October 2026

What the fast track pathway tool is

This revised tool accompanies the:

• national framework for NHS continuing healthcare and NHS-funded nursing care  (‘the national framework’) 
• NHS continuing healthcare checklist (‘the checklist’)
• NHS continuing healthcare decision support tool  (DST)

Use the tool in conjunction with the national framework, with particular reference to paragraphs 240 to 269. All staff who use the fast track tool should be familiar with the principles of the national framework and have received appropriate training.

Individuals with a rapidly deteriorating condition who may be entering a terminal phase may require ‘fast tracking’ for immediate provision of NHS continuing healthcare.

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 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 for NHS continuing healthcare.

There are a number of end-of-life pathways that may be appropriate within local health and care systems and therefore not everyone at the end of their life will be eligible for, or require, NHS continuing healthcare.

Note: the fast track pathway tool follows a standard format and should be used nationally. The content should not be changed, added to or abbreviated in any way. However, ICBs may attach their logo and additional patient identification details if necessary, for example, adding their NHS number.

Who can complete the fast track pathway tool

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. The ICB should act promptly and positively to make sure the appropriate funding and care arrangements are put in place without delay.

An appropriate clinician is defined as a person who is both:

• responsible for the diagnosis, treatment or care of the individual under the National Health Service (Consequential Provisions) Act 2006, for whom a fast track pathway tool is being completed
• a registered nurse or a registered medical practitioner

The appropriate clinician should be knowledgeable about the individual’s health needs, diagnosis, treatment or care. They should be able to provide an assessment of why the individual meets the fast track pathway tool criteria.

An appropriate clinician can include clinicians employed in voluntary and independent sector organisations that have a specialist role in end-of-life needs (for example, hospices), provided they are offering services pursuant to the 2006 act.

Others who are not approved clinicians, as defined above, but who are involved in supporting those with end-of-life needs (including those in wider voluntary and independent sector organisations) may identify that the individual has needs for which use of the fast track pathway tool might be appropriate.

In these cases, they should contact the appropriate clinician who is responsible for the diagnosis, care or treatment of the individual and ask them to consider completing the fast track pathway tool.

When to use the fast track pathway tool

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

Using the fast track pathway tool replaces the need to complete the NHS continuing healthcare checklist and the DST. However, the fast track pathway tool can 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 in a care home and wish to stay there. It can 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 that is already fully funded by the NHS) that could continue to meet their needs.

This is important because the individual may currently be funding their own care, or the local authority may be funding their care (and/or charging the individual), when the NHS should now be funding the care in full.

Using clinical judgement, prognosis and anticipation of need

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, for example:

• ‘rapidly deteriorating’ should not be interpreted narrowly as only meaning an anticipated specific or short time frame of life remaining
• ‘may be entering a terminal phase’ is not intended to be restrictive to only those situations where death is imminent

It is the appropriate clinician’s responsibility to make a decision based on whether the individual’s needs meet the fast track criteria.

An individual may at the time of consideration be demonstrating few symptoms, yet the nature of the condition is such that it is clear that rapid deterioration is to be expected in the near future.

In these cases, it may be appropriate to use the fast track pathway tool in anticipation of those needs arising, and agreeing the responsibilities and actions to be taken once they arise, or to plan an early review date to reconsider the situation.

It is the appropriate clinician’s responsibility to base their decision on the facts of the individual’s case and healthcare needs at the time.

How to use the fast track pathway tool

Appropriate clinicians should complete the accompanying fast track documentation (see the fast track pathway tool for NHS continuing healthcare referral form).

Appropriate clinicians should set out how their knowledge and evidence about the individual’s needs leads them to conclude that the individual has a rapidly deteriorating condition and that the condition may be entering a terminal phase.

In the fast track pathway tool it is helpful to include information about both:

• how the individual is presenting in their current setting
• the likely progression of the individual’s condition, including anticipated deterioration and how and when this may occur

However, ICBs should not require this information to be provided as a condition of establishing entitlement to NHS continuing healthcare.

While a completed fast track pathway tool is sufficient to demonstrate eligibility, a care plan will be required to describe the immediate needs to be met and the individual’s preferences.

This care plan should be provided with the fast track documentation, or as soon as practically possible afterwards, so that the ICB can commission appropriate care.

The setting where an individual wishes to be supported as they approach the end of their life may differ from their current arrangements. For example, an individual who is currently living in a care home setting may wish to be supported in their family environment instead.

Wherever possible, it is important that the individual receives the support they need in their preferred place as soon as is reasonably practicable, without having to go through the full process for consideration of NHS continuing healthcare eligibility.

How to involve the individual and/or their representative

The fast track process should be carefully and sensitively explained to the individual and, where appropriate, their representative. This is to support their informed and active participation, and for their views to be considered.

It is also important that the ICB understands what the individual and/or their representative have been advised about the individual’s condition and prognosis, and how they have been involved in agreeing the end-of-life care pathway.

Clinicians completing the fast track pathway tool should make the individual aware that it is important their care needs and the effectiveness of their care arrangements will need to be reviewed regularly. In doing this, there may be certain situations where a change in needs indicates that it is appropriate to review eligibility for NHS continuing healthcare. This could potentially affect the funding stream depending on the outcome of the review.

Any such decisions should be made with sensitivity. Refer to paragraphs 264 to 269 in the national framework for further details.

Taking a person-centred approach

There are several principles that underpin the NHS continuing healthcare process. The most important principle is that assessments and reviews should always focus on the individual’s needs and follow a person-centred approach.

The individual (or their representative) should be fully informed and empowered to participate actively in the assessment process and any subsequent reviews, and their views should be considered.

In addition, there are several legal requirements when it comes to an individual’s consent for parts of the NHS continuing healthcare process. Refer to ‘Consent, capacity to make a decision and information sharing’ for more information.

In the spirit of the person-centred approach, practitioners should make all reasonable efforts to seek the participation of the individual (or their representative) during each stage of the assessment and review process for NHS continuing healthcare.

For a comprehensive assessment, practitioners should consider the best evidence available at the relevant time. This should involve consideration of the individual’s (or their representative’s) view, and they should be empowered and helped to participate.

Throughout the process, this person-centred approach should be embedded in all decisions that relate to the individual’s needs assessment and their care planning.

Consent, capacity to make a decision, and information sharing

Consent is a legal requirement for any physical intervention on, or examination of, a person with capacity to give consent. To the extent that the completion of a fast track pathway tool involves such an intervention or examination, informed consent must be sought from an individual with the relevant capacity.

Refer to paragraph 85 of the national framework, which gives detailed guidance on what is required for consent to be valid.

It is necessary to obtain an individual’s explicit consent before sharing any personal data with a third party such as a family member, friend, advocate and/or other representative. Refer to the consent form for sharing information.

Consent is not required from individuals for actions necessary to meet legal requirements relating to the NHS continuing healthcare process. These actions include:

• the carrying out of the checklist or assessment process by health and social care professionals
• the sharing of relevant information between health and social care professionals and the care providers involved where this is necessary for the purpose of direct patient care

If there is a concern that the individual may not have capacity to give consent to a physical intervention or examination that is part of the assessment process, or to the sharing of personal data with third parties such as a family member, friend, advocate and/or other representative, this should be determined in accordance with the Mental Capacity Act 2005 and the associated code of practice.

It may be necessary to make a ‘best interests’ decision, bearing in mind the expectation that everyone who is potentially eligible for NHS continuing healthcare should have the opportunity to be considered for eligibility. Refer to paragraphs 86 to 96 of the national framework for guidance on the application of the Mental Capacity Act 2005 in such situations.

The fact that an individual may have significant difficulties in expressing their views does not necessarily mean that they lack capacity to make a decision. Appropriate support and adjustments should be made available in line with the Mental Capacity Act 2005 and with the Equality Act 2010.

The organisation proposing to share the individual’s health and/or care information with friends, family members and representatives must ensure personal data is processed in line with data protection laws and relevant regulations.

The duty to share information (for the purposes of providing an individual with health or adult social care) as set out in section 251B of the Health and Social Care Act 2012 applies to assessments for NHS continuing healthcare.

Careful decision-making is essential in order to avoid causing the undue distress that might result from changes in NHS continuing healthcare eligibility within a very short period of time.

Appropriate clinicians should complete the accompanying fast track pathway tool for NHS continuing healthcare referral form published alongside this guidance.