Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. Department of Health and Social Care (2022) NHS Continuing Healthcare Fast Track Pathway Tool.
3. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
4. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
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This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains how quickly NHS Continuing Healthcare Fast Track funding should be put in place once a Fast Track Pathway Tool has been completed. It covers the urgency the Framework expects, why Fast Track exists as a separate route, the common causes of delay, what should happen to care in the meantime, how to escalate, and the position on backdating.
How quickly Fast Track funding should start
The whole purpose of Fast Track is speed. Once an appropriate clinician has completed the Pathway Tool, funding should be put in place urgently, measured in hours rather than weeks. Delay defeats the point of the route entirely.
Why the route exists
Fast Track exists because the standard NHS Continuing Healthcare process, with a Checklist, a full multidisciplinary assessment and a Board decision, takes far too long for someone whose condition is deteriorating rapidly. The route strips out those steps precisely so that funding can follow the clinical judgement immediately rather than after a process lasting weeks.
What should happen on receipt
A properly completed Fast Track Pathway Tool from an appropriate clinician should be accepted by the Integrated Care Board and acted on urgently. The Board is not expected to reassess the clinical judgement, to require a Decision Support Tool, or to convene a panel. Its task is to commission the package, not to re-run the decision.
Common causes of delay
The most frequent are the tool being returned as incomplete, the Board seeking further clinical evidence it is not entitled to require, difficulty sourcing a care package at short notice, and disputes about the setting in which care should be delivered. Sourcing genuinely takes time, but the first two are avoidable and worth challenging directly.
Care while funding is arranged
Care must not be interrupted while commissioning is arranged. Where a package is already in place under a private or local authority arrangement, it should continue, with funding responsibility resolved afterwards. If you are being asked to keep paying while a completed Fast Track tool sits unactioned, say in writing that payment is made pending the outcome.
How to escalate
Contact the Board's continuing healthcare team in writing, state the date the tool was completed and by whom, and ask for confirmation of when funding will be in place. If there is no substantive response, escalate to the Board's complaints team, and ask the completing clinician to make contact as well. Clinical pressure frequently moves these situations faster than family contact alone.
Backdating
Where funding is delayed, it should generally take effect from the point at which it should have been put in place rather than from when commissioning was finally completed. Where care was paid for in the interim, raise reimbursement explicitly, referencing the date the tool was completed rather than the date the Board acted.
When time is very short
Where the person is expected to die within days, say so plainly in writing to the Board and ask for the matter to be escalated immediately. It is an uncomfortable thing to have to write, but it is often what moves a case, and it also creates the written record needed if reimbursement is pursued afterwards.
Key takeaway
Fast Track funding should follow a completed tool urgently, measured in hours rather than weeks. Care must continue meanwhile, delay should not reduce entitlement, and backdating should run from when funding should have started.
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Frequently asked questions
How quickly should funding start?
Urgently, measured in hours rather than weeks. The route exists specifically to avoid the delay of the standard process, so a completed tool should be acted on immediately rather than queued.
Can the Board delay while it reviews the tool?
It should accept a properly completed tool from an appropriate clinician and commission the package. Seeking further clinical evidence it is not entitled to require is a common cause of delay and worth challenging in writing.
What happens to care while we wait?
It must continue. Where a package is already in place it should not be interrupted, and if you are still paying, confirm in writing that payment is made pending the outcome so reimbursement can be pursued.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.