What is Discharge to Assess?

Imagine this: you've been in hospital—perhaps after a fall, an operation, or an unexpected illness. You’re stable, medically ready to leave, and desperate to be somewhere quieter, more familiar. But instead of going straight home, you’re stuck waiting for decisions about your long-term care—decisions that could take days or even weeks to finalise.

Discharge to Assess (D2A) was created to solve this very problem.

Rather than keeping people in hospital while care needs are assessed, D2A enables a much-needed shift: get people out of hospital as soon as they’re medically fit and carry out those assessments somewhere more appropriate—at home, or in a short-term care setting. It’s a model designed to support quicker recovery, reduce pressure on hospitals, and improve the way long-term care is planned.

In principle, it’s a compassionate, efficient approach. But in practice, the path from hospital to care isn’t always so smooth.

One of the biggest challenges lies in the information gap. Details shared by hospital staff about a patient’s condition, preferences, or support needs are often missing, incomplete, or out of date. Care providers might receive only vague notes—if any at all—making it hard to prepare properly for someone’s arrival.

There can also be a disconnect between hospital staff and social care providers. Relationships between the two sides are often transactional, rushed, or even, in some cases, non-existent. Discharge teams are under intense pressure to free up beds, and with limited knowledge of what local care services actually offer, they may default to what’s available rather than what’s truly suitable.

Meanwhile, families are left trying to make urgent decisions with very little guidance, unsure who to trust or where to turn.

So while Discharge to Assess is a step forward, helping people leave hospital earlier and in better shape, it also highlights some long-standing cracks in the system: poor communication, disjointed care planning, and a lack of transparency about what support is actually out there. 

The good news? Those challenges are solvable—with better tools, better connections, and a shared understanding across the system.

Discharge to Assess pathways

No two people leave hospital with the same story. Some are returning home to familiar routines, others are stepping into the unknown. Discharge to Assess recognises this truth—and that’s why it isn’t a single track, but a series of pathways, each one designed to match the complexity of a person’s needs with the support required for their next step.

These are the four nationally recognised D2A pathways. At their best, they’re not just categories—they're bridges between hospital and home, between crisis and stability.

Pathway 0: Home, no formal support needed

For some, discharge is simple. They’re well enough to go home, and with no new care needs identified, they can carry on as before. No care package. No temporary placement. Just a return to normality.

But even here, timing matters. A swift discharge back to independence prevents unnecessary deterioration. It’s a reminder that sometimes, the best care is to step back—and let someone go home.

Pathway 1: Home, with support

This is the most common route—and perhaps the most underestimated.

People on Pathway 1 are able to return home, but they can’t do it alone. They may need reablement support, domiciliary care, equipment or adaptations—things that will help them rebuild confidence, mobility, and independence over time. The support might be temporary, or it might evolve into something longer term.

What makes Pathway 1 powerful is its potential: it’s where recovery and self-sufficiency are nurtured, right in the heart of someone’s own home. But it only works when the right services are available, understood, and in place from day one.

Pathway 2: Short-term care bed in a residential or community-bedded setting

When home isn’t immediately an option, pathway 2 offers a crucial in-between step: a safe place to recover, reflect, and be properly assessed.

This might be a care home, hospice, or a specialist setting where someone can receive the clinical or rehabilitative support they need. It’s not about placement for the sake of convenience—it’s about giving people time. Time to heal, time to regain strength, and time for the system to understand what’s truly best for them in the long run.

Without this buffer, decisions get rushed. People get placed in settings that don’t meet their needs. Families feel overwhelmed. Pathway 2 is a chance to slow things down just enough to get it right.

Pathway 3: Complex or intensive needs

Pathway 3 is for those with the most complex needs—people who may not be able to return home and require ongoing, often specialist care. This could include those with advanced dementia, significant mobility challenges, or end-of-life needs.

These are sensitive, deeply personal situations. The decisions made here have lifelong consequences. So while this pathway might involve a transition to residential or nursing care, it should never be reduced to “finding a bed.” It’s about finding the right place, with the right expertise, where someone can live with dignity and the right support around them.

Each pathway is a lifeline in its own way—but none of them work in isolation. They rely on coordination, communication, and the timely sharing of information across hospitals, families, and care providers. They rely on knowing what services are out there—and which are truly available in the moment care is needed.

Because ultimately, D2A pathways aren’t just routes out of hospital—they’re the first steps toward recovery, stability, and a new chapter in someone’s life. And getting those first steps right matters.

Why is it important?

Hospitals are extraordinary places. They save lives, stabilise emergencies, and provide the kind of medical care that simply can’t happen anywhere else. But as miraculous as hospitals can be, they are not designed for long stays—especially for those no longer in need of acute treatment.

For older adults in particular, every extra day in a hospital bed carries hidden risks. Muscles weaken through inactivity. Independence slips away. The longer someone stays, the harder it can be to return to life as they knew it. There’s even a name for it: hospital-associated deconditioning—a gradual decline that’s all too common, and all too preventable.

Then there’s the emotional toll. Hospitals are busy, clinical spaces. They can be disorienting, lonely, even frightening—especially for people living with dementia or complex needs. The longer someone waits to be discharged, the more likely they are to feel confused, powerless, or forgotten.

Discharge to Assess is a system that was supposed to fix that.

The theory is that by enabling people to move on from hospital quickly, D2A could protect them from unnecessary decline.

For the NHS, every delayed discharge is a ripple effect: a bed blocked means someone else waits in A&E, elective surgeries are postponed, ambulance crews queue up outside, and staff are stretched to breaking point. Discharge to Assess was supposed to break that cycle. However, the system is not without its challenges.

Many in the social care sector believe that D2A simply ends up shifting vulnerable patients to different care settings or environments that may not be suitable. Our next section explores the key challenges with the hospital discharge process.

Challenges with Discharge to Assess

In theory, Discharge to Assess should be a seamless bridge from hospital to home, care setting, or independence. But in reality, that bridge is often rickety, fragmented, and missing critical planks.

At the heart of the problem is a lack of clear, accurate, and timely information sharing. Home care agencies and care homes frequently receive incomplete—or completely inaccurate—referrals.

According to statistics published within the Hospital Discharge Report from Autumna, 45.5% of care providers say information provided by hospital discharge teams is not accurate. Vital details about a person’s condition, preferences, risks, or family involvement are often missing. Some providers report receiving nothing more than a name and an expected time of arrival. In a system built on trust and readiness, that’s a dangerous gap.

Then there’s the relationship—or lack thereof—between hospital discharge teams and care providers. The Autumna report also showed that more than a third (34.0%) of providers who receive referrals from hospital discharge teams say they don’t have a positive relationship with them, while 33.4% said they can’t talk to discharge teams when they need to.

These relationships are often transactional rather than collaborative, with hospital teams under pressure to discharge quickly, and social care providers expected to “make it work” without any meaningful dialogue. There’s little time for discussion, context, or confidence-building. Care becomes a rush job instead of a carefully planned transition.

The result? Wrong care, wrong setting, wrong outcome.

Someone may be placed in a home that doesn’t meet their clinical or emotional needs. A provider may accept a person whose needs they’re not fully equipped to support—leading to placement breakdowns, readmissions, and trauma for families who thought the crisis was over.

Another major challenge is that discharge teams often don’t fully understand what providers actually offer, with 48.7% of providers citing this as an issue.

The social care sector is rich and diverse—ranging from reablement-focused home care to specialist dementia units with cutting-edge technology. But with limited visibility and no centralised way to compare services, hospital teams are left making decisions based on availability, not suitability. Indeed, 40% of social care providers receive no contact at all from their local hospital discharge team.

In many cases, these problems are exacerbated by outdated processes—manual spreadsheets, phone calls, and frantic last-minute emails—all while beds are needed, families are waiting, and providers are scrambling for clarity.

Autumna’s internal data reflects the urgency: care providers regularly report a mismatch between the information they receive and the needs of the individual arriving. For a system built on speed, that’s not just inefficient—it’s unsafe.

Discharge to Assess can’t work properly without trust, transparency, and real-time insight. And right now, those are in short supply.

How Autumna can help

The good news? These challenges can be overcome. With the right tools and smarter collaboration, we can rebuild the broken links between hospital teams and care providers—ensuring that discharges are not just fast, but safe, informed, and right for each individual.

For example, Autumna has a tool known as DAD (Dashboard for Accelerated Discharge) which can help discharge and brokerage teams identify suitable care providers in just 60 minutes.

Another easy way to get matched to the right providers is to use our shortlisting tool. All you have to do to get started is answer a few quick questions and be matched with a list of providers based upon your answers. This means that the list of providers you will receive will be highly personalised and relevant to your circumstances.

If you need additional help, feel free to contact our advice team on 01892 335 330.