Digitalising fast-track pathway to improve access to urgent end-of-life care

This CW Innovation Fellowship case study explores the digitalisation of the NHS Continuing Healthcare (CHC) Fast Track pathway, in collaboration with the North West London Acute Provider Group. The digital transformation project is led by Odile Taylor, Highly Specialist Occupational Therapist in HIV, Oncology and Palliative Care and CW Fellow.

Transforming the NHS Fast Track Continuing Healthcare (CHC) Pathway across the North West London Acute Provider Group

Project summary: A cross-organisational programme across North West London to transform the NHS Continuing Healthcare (CHC) Fast Track pathway by replacing three paper-based documents with a single Cerner workflow.

Story of the project

National policy emphasises that people should be supported to receive care in a preferred setting, with timely access to services that maintain dignity, comfort and choice.

One of the key tools for achieving this is the NHS Continuing Healthcare (CHC) fast-track pathway, which enables individuals with a rapidly deteriorating condition to access an urgent package of care within 48 hours.

The effective and timely operation of the CHC pathway remains essential for supporting patient choice and reducing avoidable hospital stays. Yet, this analogue system can create delays at this critical stage of life.

I have the privilege of supporting many people to return home to their preferred place of death in my role. Over the years, I became acutely aware that both patients and clinicians were often unfamiliar with NHS Continuing Healthcare (CHC) Fast Track funding and the complex processes required to access it.

The paper bureaucracy became a source of great frustration, as I saw opportunities for people to die in their preferred place lost while forms were completed, coordinated and approved. I felt this was a profound injustice, shared by many colleagues.

Digitalising the CHC pathway, in collaboration with North West London Acute Provider Group, has the potential to shape a safer, more compassionate and efficient service. The project includes the developing patient information resources, contributing to clinician education and gathering stakeholder feedback.

Delivering regional transformation

The North West London Acute Provider Group brings together four NHS Trusts: Chelsea and Westminster NHS Foundation Trust; The Hillingdon Hospitals NHS Foundation Trust; Imperial College Healthcare NHS Trust; and London North West University Healthcare Trust. This accounts for 12 hospitals, serving approximately 2.2 million people.

Working across north west London is more complex than delivering change within a single Trust because organisations have different governance arrangements, digital systems and highly variable established ways of working. Building consensus requires strong stakeholder engagement, flexibility and shared ownership.

Developing common outcome measures and collecting baseline data across the collaborative will support benchmarking, continuous improvement and sustainable change during the project, delivering greater benefits for patients than could be achieved through a single Trust initiative alone.

This system-wide approach creates significant opportunities, such as reducing unwarranted variation, promoting equitable access to Fast Track Continuing Healthcare and enabling shared learning between organisations.

Outcomes

The project is being implemented across north west London through collaboration between acute trusts and the Integrated Care Board. Progress includes:

• Development of a collaborative patient information leaflet written in plain language.
• Shaping digitalisation of three paper forms into a single Cerner workflow.
• Multidisciplinary stakeholder workshops involving medical, nursing, allied health and commissioning teams.

Key recommendations include a digital-first workflow, quarterly pathway reviews, earlier virtual environmental assessments and improved data collection.

The project will establish baseline measures that currently do not exist, including referral times, repeat submissions, rejection reasons and discharge outcomes, enabling continuous quality improvement.

Advancing the project through CW Innovation Fellowship collaboration

CW Innovation Fellow: Odile Taylor

Role: Highly Specialist Occupational Therapist in HIV, Oncology and Palliative Care
Organisation: Chelsea and Westminster Hospital NHS Foundation Trust

Odile applied for the Fellowship to develop the leadership, quality improvement and implementation skills needed to deliver sustainable system-wide change. The programme exceeded Odile’s expectations by combining practical quality improvement methods with leadership development, multidisciplinary networking and access to a mentor specialising in digital transformation.

The most valuable part [of the CW Innovation Fellowship] has been meeting other like-minded individuals who have been equally moved by their patients and colleagues. Seeing others strive for social justice, and learning so much about different ways of communicating with different audiences, has broadened my perspective and enriched both my practice and this project.

The practical workshops, delivered by innovation specialists from outside clinical practice, translated improvement theory into tools that Odile could apply immediately to the project. A stand-out was the psychologist’s sessions on conflict resolution and the regular huddles with other Fellows, which provided valuable opportunities for reflection, shared learning and peer support.

The Fellowship strengthened my leadership, stakeholder engagement and quality improvement skills, giving me greater confidence to lead sustainable transformation that improves end-of-life care across north west London.

Overall, being part of the Fellowship has strengthened Odile’s confidence in leading complex projects, engaging stakeholders and applying improvement methodology to real clinical challenges.

Next steps

The next phase will embed the digital fast-track pathway through education, governance and continuous improvement. This includes:

• Developing short training videos to share on Vimeo.
• Stimulating Trust-specific and North West London-wide digital education materials.
• Disseminating understanding of the new digital dashboards to monitor pathway performance
• Promoting earlier virtual environmental assessments through the use of ISLA.

Longer term, the project aims to encourage both the public and healthcare professionals to see death as a social event, rather than a medical one, supporting more open conversations, earlier planning and compassionate, person-centred end-of-life care.

For more information on the CW Innovation Fellowship, which was previously called the Horizon Fellowship, visit the CW+ website. Visit the Innovation Directory to see this year’s Fellows and read more about their projects.