Discharge to Assess pathway (D2A)

Discharge to Assess is how the NHS in England moves a medically optimised patient out of hospital and into the right setting for proper assessment. Four pathways, one principle: assess in the right place, not the hospital.

The short answer. Discharge to Assess (D2A) is the NHS England policy that pushes assessment for long-term care out of hospital. Pathway 0 is straight home with no extra support. Pathway 1 is home with reablement. Pathway 2 is bed-based reablement. Pathway 3 is 24-hour bed-based care with assessment for long-term placement. The NHS funds the assessment window, usually up to 6 weeks.

The four pathways

Pathway 0. Straight home, no support. Most simple discharges.
Pathway 1. Home with reablement. 50 percent of D2A cases.
Pathway 2. Bed-based reablement in a care home or community unit. Time-limited (typically 2-4 weeks).
Pathway 3. 24-hour bed-based care for people unlikely to recover the level of independence to return home. Assessment for long-term placement runs alongside.

NHS England D2A ↗

Who chooses the pathway

The discharge team (a multi-disciplinary group including hospital nurse, therapist and social worker) chooses based on the patient's needs and the family's preferences. The family does not get a veto on a safe pathway, but you can ask the rationale to be written into the discharge plan.DHSC guidance ↗

What the NHS pays for

During the assessment window (typically up to 6 weeks) the NHS funds the full cost of the chosen pathway. This is not means-tested. After week 6 the funding switches to standard arrangements (council-funded under means test, or self-funded), unless a CHC Fast Track is signed.NICE NG74 ↗NICE NG27 ↗

What happens at week 6

The full assessment is completed. The patient is now either ready to step down (lower level of support, or none at all), or needs long-term care. The funding source changes accordingly. Many families are caught off guard by this and start a long-term financial plan only at week 6.

Frequently asked

Does D2A only apply to over-65s?

No. D2A applies to any medically optimised patient who needs assessment for ongoing care. Younger adults with long-term conditions use the same routes.

Can the family request a specific pathway?

You can express a preference. The discharge team decides based on safety and what the assessment requires. Always insist on a written decision rationale.

What if the chosen pathway turns out to be wrong?

Pathway can be reviewed during the window. A patient on Pathway 1 (home) who is not coping can be moved to Pathway 2 (bed-based) with a new assessment.

Last reviewed 2026-06-21. Clinical reviewer pending appointment (target Sep 2026); meanwhile reviewed by the editorial team.