The NHS CHC Fast Track is one form, one signature, one legal target: a decision inside 48 hours, with the NHS paying for all care. Here is exactly how it works.
The short answer. A senior responsible clinician (consultant, GP, hospice doctor, senior palliative or community matron) signs the Fast Track Pathway Tool. The form states the patient has a primary health need and is rapidly deteriorating, possibly entering a terminal phase. The local Integrated Care Board (ICB) CHC team must decide within 48 hours. Once approved, the NHS funds all care in any setting: care home, hospice or at home.
Who can sign
- Hospital consultant or speciality registrar.
- GP (including out-of-hours GP).
- Hospice doctor.
- Senior nurse: palliative, community matron, district nurse team leader.
- Clinical Nurse Specialist with prescribing rights, in some areas.
Fast Track Pathway Tool ↗
What the form needs to say
The Fast Track template is two pages. It must record a primary health need, evidence of rapid deterioration, and a brief plan of care. The clinician does not need to predict prognosis to the day, only confirm rapid decline. CHC Framework ↗
48-hour timeline
Hour 0
Clinician signs Fast Track Pathway Tool.
Hour 0-12
Form submitted to ICB CHC team. Care arrangements may begin immediately.
Hour 12-48
ICB makes the decision (target). Refusals are rare for clear-cut end-of-life cases.
Day 2-7
Bed identified. NHS commissioning team books the placement and arranges transfer.
Day 90
First review. Continue Fast Track, transfer to standard CHC, or step down.
Once approved, who arranges the bed
The ICB CHC team has its own commissioning function. They contact preferred homes and hospices directly. Family can express preferences but cannot delay placement indefinitely. The Marie Curie guide is the clearest charity-side summary. Marie Curie CHC ↗
If the form is refused
Ask in writing for the reason and request a Decision Support Tool (DST) full assessment under standard CHC, which produces a more detailed scoring. Appeals against a Fast Track refusal go to the ICB review panel within 6 months.
Frequently asked
Does the patient have to be dying?
No. The form says rapidly deteriorating and may be entering a terminal phase. Many Fast Track placements run for months because rapid decline does not always end in days.
Can family request the form?
Yes. Ask the GP, hospital consultant or hospice team to consider Fast Track. They can refuse if they judge the patient is not rapidly deteriorating, but they must record the reason.
Does Fast Track pay for accommodation as well as nursing?
Yes. Fast Track covers the full weekly care home or hospice rate, including bed, board, nursing care, equipment and consumables.
Last reviewed 2026-06-21. Clinical reviewer pending appointment (target Sep 2026); meanwhile reviewed by the editorial team.