CHC Fast Track vs Discharge to Assess
Both pathways move a hospital patient into the community. They are very different in scope and funding. Pick the wrong one and the family pays thousands per week from week 7.
The short answer. CHC Fast Track applies when the patient has a primary health need and is rapidly deteriorating. It is fully NHS-funded indefinitely. Discharge to Assess applies for any medically optimised patient. It is NHS-funded for up to 6 weeks only. Ask for Fast Track whenever rapid decline is plausible - the worst that can happen is refusal, and the upside is permanent NHS funding.
Which route applies
- CHC Fast Track. Primary health need, rapidly deteriorating, may be entering a terminal phase.
- D2A. Medically optimised, needs assessment for ongoing care.
CHC Framework ↗Fast Track Tool ↗NHS England D2A ↗
Who decides
- Fast Track. Signed by a senior clinician (consultant, GP, hospice doctor, senior palliative nurse). Decided by the ICB CHC team within 48 hours.
- D2A. Decided by the hospital discharge multi-disciplinary team in conjunction with the council.
Speed and duration
- Fast Track. Decision in 48 hours. Funding indefinite (with periodic review).
- D2A. Decision in 24-48 hours. Funding for up to 6 weeks.
Switching mid-stay
Yes - a patient on D2A who deteriorates can be Fast-Tracked. The CHC application can be made by the Pathway 2 or 3 care home clinical lead, the GP, or a visiting palliative team.
Frequently asked
Why would the team push D2A when Fast Track might apply?
Fast Track approval rates vary by ICB. Some teams default to D2A because it is faster to arrange and avoids a contested decision. Always ask the question yourself if rapid decline is plausible.
If Fast Track is refused, can we appeal?
Yes. Request a Decision Support Tool (DST) full CHC assessment. Appeal to the ICB review panel within 6 months of refusal.
Does Fast Track always end in death?
No. Some Fast Track approvals last months, occasionally years. The 3-month review can downgrade to standard CHC or transfer to the council.
Last reviewed 2026-06-21. Clinical reviewer pending appointment (target Sep 2026); meanwhile reviewed by the editorial team.