Continuing Healthcare: Fast track to nowhere?

Continuing Healthcare allows a person’s care and support to be fully funded through the NHS (provided they can be described as having a “primary health need”). In 2016 around 207,000 people applied for CHC support; 40 per cent of these were applying for the “Fast Track” Pathway.

Fast Track CHC – which circumvents the lengthy assessment processes mandatory for standard CHC – is designed to ensure individuals approaching end of life can have a care package in place as soon as possible, in a setting of their choosing.

NHS guidance makes clear that once a clinician identifies an individual as being in need of Fast Track CHC and makes an application to the local clinical commissioning group, the CCG is obliged to have a care package in place for that person within 48 hours.

Given the importance of meeting this target, Marie Curie undertook a series of Freedom of Information requests to CCGs to build a picture of how well Fast Track is being delivered across England.

Significant gaps

We found significant variation as well as gaps in the information being gathered by many CCGs: Two thirds of those who responded were not able to tell us how long it took them to get Fast Track CHC packages in place.

Currently we simply don’t have the information we need to make a proper assessment of what exactly is going wrong, and how we can put it right

From the data provided, we saw disparities between CCGs in the average time taken to implement Fast Track care packages. Less than a third of CCGs who provided data were meeting the 48 hour target. A further one third indicated the average waiting time exceeded a week. Some had average waits of two weeks or more.

CCGs indicated that a number of factors were contributing to these delays, including difficulties finding beds in suitable care homes, rapid deterioration of patients preventing discharge, and CHC services only running from 9am-5pm Monday to Friday, creating delays over weekends.

On the other side, we found that CCGs performing particularly well often had a dedicated point of contact for Fast Track CHC – supporting hospital staff and facilitating the application process. This link is only suggested, but we believe that it warrants further investigation. It is clear that delivering Fast Track can be a complicated and challenging undertaking.

Together our findings paint a challenging picture: We are aware of serious delays in some CCGs, but simultaneously there are substantial inconsistencies in how CCGs are gathering data.

We know there is a problem with Fast Track CHC, but in order to find solutions we need to have a much more consistent understanding of why delays are occurring across the country. Currently we simply don’t have the information we need to make a proper assessment of what exactly is going wrong, and how we can put it right.

It is the responsibility of NHS England to ensure CCGs are gathering appropriate data on Fast Track CHC. We will be urging NHS England to act on pushing for new data gathering standards which would provide the tools needed to get Fast Track back on track.

A full report on our findings, Making Every Moment Count, is available for download on the Marie Curie website