PP-44 NHS continuing healthcare fast track funding audit

Introduction NHS Continuing Healthcare Fast Track (CHCFT) funding enables rapidly deteriorating patients to receive care in their preferred place in the final weeks of life. However, outcomes for CHCFT patients are not routinely monitored. Aims Investigate characteristics and trends of those dying with CHCFT referral over time, and compare with those who died without CHCFT in the same period. Methods A retrospective review of CHCFT referrals at University Hospitals Bristol and Weston NHS Foundation Trust from March 1-April 30 across four consecutive years (2021-2024). A sample of patients referred for CHCFT who died pre-discharge had an in-depth assessment, identifying themes for delays. Results Over four years, 292 patients were referred for CHCFT (median age 81 years); 53.8% (n=157) were referred to specialist palliative care. Malignancy was the most common diagnosis (55.1%, n=161) followed by cardiovascular disease (9.9% (n=29)). 38.7% (n=113) died before discharge, increasing from 36.1% in 2021 to 40.7% in 2024. Median hospital stay was 23 days, with median time from referral to death 22 days. 79.8% (n=233) died within 90 days of referral. 42.5% (n=124) of referrals were cancelled (reasons: patient choice, early discharge, inpatient death, criteria not met). Survival was similar for rejected and approved referrals (median 37 vs. 34 days) though rejected patients had shorter stays (median 7 vs.15 days). 10 referrals were rejected for not meeting CHCFT criteria; 60% (n=6) of these patients died. 33 patients had referrals cancelled due to ‘death before discharge’, delays were attributed to discharge team delays, funding decisions, patient deterioration and late funding applications, losing 5.75 days per patient . Conclusion 38.7% of CHCFT-eligible patients died in hospital before discharge. Most (79.8%) die within 90 days regardless of referral outcome. Impact CHCFT fails to deliver timely discharge. All CHCFT referrals have a similar prognosis, questioning whether assessment for eligibility is warranted.