Discharge to assess (D2A) explained: pathways, rights and support

Discharge to assess (D2A) is the NHS model where you leave hospital as soon as you are medically ready and your longer-term care needs are assessed afterwards, usually at home. Council reablement and intermediate care that follow are free for up to six weeks. The guidance expects the vast majority of people to go home, with short-term recovery support where needed.

At a glance

• NHS England introduced D2A as best practice in 2016. The current Hospital Discharge and Community Support guidance was first published on 31 March 2022.
• Pathway 0 is home with no new needs, pathway 1 is home with new or extra support, pathway 2 is a short stay in a community bed, and pathway 3 is a new residential or nursing home placement.
• Longer-term needs should be assessed once you are stable, and ideally at home, not in a crisis.
• Patients and unpaid carers should be involved in discharge planning.
• You do not have the right to stay in a hospital bed once you are medically ready, while waiting for your preferred option.

What is discharge to assess, and why does it exist?

Under D2A, people receive short-term care, rehabilitation or reablement when needed, and their longer-term needs are assessed once they reach a stable point of recovery. NHS England says the aim is to avoid unnecessary time in hospital. Long stays can worsen health and increase long-term care needs, especially for older people, and people with frailty recover more slowly from illness or injury.

The idea is “home first”. Assessment in the person’s own home gives a truer picture of what they can do than a ward does. The government’s guidance says assessments should not take place during an acute crisis, and that for people with palliative needs they should happen once the person is as stable as they are likely to become. Full NHS continuing healthcare assessments normally take place in a community setting. Our guide to care after hospital discharge covers the practical side, and our hospital discharge checklist can be printed.

What are discharge pathways 0 to 3?

The Hospital Discharge and Community Support guidance (first published 31 March 2022) groups discharges into four pathways:

The guidance describes most discharges as simple, with most people who have complex needs going home with short-term support, and only a small proportion needing bed-based care. If your relative is offered pathway 3, ask why pathways 1 or 2 are not possible, and ask for a review. The reason for caution is that a study of 10,400 care pathways found that between 32% and 54% of people with delayed discharge went to settings unsuited to their needs, and 92% of those received more intensive care than they required.

How long does support last, and does it cost anything?

Local authority reablement and intermediate care are provided free of charge for up to six weeks. The six weeks is a maximum, and the length depends on your needs and recovery. If you still need care after that, a longer-term needs assessment decides what happens next. Our guide to six weeks of free care after hospital explains what is and is not covered, and reablement describes the service. See also what happens after reablement ends.

• Funding: the NHS and councils can pool funding through section 75 agreements and mechanisms such as the Better Care Fund. This is why you may see a mix of NHS and council staff involved.
• Self-funders: people who would pay for their own care should receive clear information about costs.
• Beyond six weeks: you may be charged after a financial assessment. See social services care packages explained.

What are your rights during discharge?

• Involvement: patients and unpaid carers must be involved in discharge planning where appropriate.
• Carers: unpaid carers can request a carer’s assessment, and young carers are entitled to their own needs assessment. See the carer’s assessment.
• Advocacy: people without family or friends to support them are entitled to an independent advocate. See what advocacy in social care is.
• Lasting power of attorney: an attorney should be consulted where relevant. See lasting power of attorney.
• Choice: you should be offered choice of services where possible. However, the guidance says you have no right to remain in a hospital bed while waiting for your preferred option.

If you think the discharge is unsafe, say so in writing to the ward manager and see unsafe hospital discharge. Complaints about NHS bodies can go to the Patient Advice and Liaison Service (PALS) and the Parliamentary and Health Service Ombudsman. Complaints about councils or care providers can go to the Local Government and Social Care Ombudsman. Healthwatch and CQC also accept concerns.

What should you ask before leaving hospital?

Use the discharge conversation to get clear answers. Our hospital discharge checklist adds more.

• Which pathway is this, and who is coordinating it?
• Is there a named contact in the hospital and in the community?
• What support starts on day one, and who visits?
• When and where will longer-term needs be assessed, and by whom?
• Is any equipment, such as a bed, commode or grab rails, ready at home?
• What medicines is the person taking, and has the pharmacy or GP been told about any changes? See medication support at home.
• Has an NHS continuing healthcare checklist been considered, and when would a full assessment take place?
• What happens if it is not working, and who do we phone?

Pay attention to how long the person can manage alone, whether food and heating are in place and whether a carer is coping. If the person has dementia, tell staff what helps them. Read dementia and living alone for risks.

What happens when the D2A period ends?

The aim is a decision about longer-term support when the person has recovered as far as they are likely to. The main outcomes are:

• No further help needed: the person is independent again, perhaps with equipment or technology.
• Council-funded support: the council assesses needs against the national eligibility criteria and, if needs are eligible, arranges a care package and carries out a financial assessment. See social services care packages and the financial assessment.
• NHS continuing healthcare: if the person has a primary health need, the NHS may pay for the full package. Our CHC checklist guide and the NHS continuing healthcare checker explain. The assessment normally takes place in the community, not on the ward.
• Self-funding: if the person has capital above the upper limit in England of £23,250, they usually arrange and pay for care themselves. See self-funding care.
• Longer-term residential care: if the person moves to a care home, see moving a parent into a care home and how to choose a care home.

Frequently asked questions

What does discharge to assess mean?

It means you leave hospital when medically ready, with any longer-term care needs assessed afterwards once you are stable, ideally at home. The aim is to avoid unnecessary time in hospital, particularly for older people with frailty.

What are discharge pathways 0, 1, 2 and 3?

Pathway 0 is home with no new needs. Pathway 1 is home with new or extra support. Pathway 2 is a short stay in a community bed for recovery. Pathway 3 is a new residential or nursing home, for exceptional circumstances only.

Is care after hospital free?

Local authority reablement and intermediate care are free for up to six weeks. After that, longer-term care may be charged following a financial assessment, unless the NHS funds it through continuing healthcare. Self-funders should be given clear cost information.

Can I refuse to be discharged?

You can raise concerns, ask for a review and request support, but you have no right to stay in a hospital bed once you are clinically ready, while waiting for your preferred option. If you believe the plan is unsafe, put it in writing and use the complaints routes.

Who assesses long-term needs after discharge?

The council assesses care and support needs, ideally in the person’s own home once they are stable. NHS continuing healthcare eligibility is normally assessed in a community setting. You can ask for a carer’s assessment and an advocate.

Where to get help next

Ask the hospital discharge team for a named contact, and use the guides above while you plan. Our care search helps find local home care or short-term care homes. In London, see home from hospital services in London, and for recovery stays see convalescent care.

Sources

• GOV.UK: Hospital discharge and community support guidance
• NHS England: Discharge to assess

Reviewed by The Care Panel team on 9 November 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.