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NHS Hospital Discharge Process UK 2026 — Delayed Transfers & Care Coordination
Complete guide to NHS hospital discharge process in the UK — reducing delayed transfers of care (DTOC), discharge to assess model, home first approach, care coordination, and discharge software.
DTOCs cost the NHS £300+ million annually and block 2,500+ acute beds. The Discharge to Assess model reduces LOS by 2-3 days and DTOCs by 40%.
NHS Discharge Pathways
| Pathway | Description | % of Patients |
|---|---|---|
| Pathway 0 | Home, no support needed | 40% |
| Pathway 1 | Home with short-term support (reablement) | 30% |
| Pathway 2 | Care home for rehabilitation, then home | 15% |
| Pathway 3 | Care home, long-term | 10% |
| Pathway 4 | Complex ongoing health needs (CHC) | 5% |
Discharge to Assess (D2A) Model
- Medical fitness: Consultant confirms medical fitness for discharge
- Discharge home: Patient discharged home same day with support package
- Home assessment: Therapy and care assessment at home within 48 hours
- Reablement: Short-term reablement (up to 6 weeks) to regain independence
- Ongoing care decision: Determine if ongoing care needed after reablement
- Equipment and adaptations: Arrange grab rails, stairlifts, telecare as needed
- Medication support: Pharmacy support for medication management at home
Common DTOC Causes & Solutions
| Cause | % of DTOCs | Solution |
|---|---|---|
| Waiting for care home placement | 35% | Pre-book placements, expand care home capacity |
| Waiting for home care package | 25% | Rapid response home care, reablement |
| Waiting for equipment/adaptations | 15% | Equipment loan store, fast-track installation |
| Awaiting CHC assessment | 10% | Fast-track CHC, discharge to assess |
| Family/family disagreement | 8% | Family conferences, mediation |
| Awaiting transport | 7% | Hospital transport booking system, volunteer drivers |
Frequently Asked Questions
- What are Delayed Transfers of Care (DTOCs)?
- DTOCs occur when a patient is medically fit for discharge but remains in hospital due to waiting for social care, community support, or care home placement. DTOCs cost the NHS £300+ million annually and block acute beds. The NHS target is < 2.5% of beds occupied by DTOC patients.
- What is the 'Discharge to Assess' model?
- Discharge to Assess (D2A) moves assessment for ongoing care needs out of hospital and into the community. Patients are discharged home as soon as medically fit, with assessment and rehabilitation provided at home. D2A reduces LOS by 2-3 days and DTOCs by 40%.
- What is the 'Home First' approach?
- Home First is the NHS principle that all patients should be discharged home unless there's a clinical reason for institutional care. It assumes patients recover better at home. Support packages (reablement, home care, equipment) are arranged to enable home discharge. 90% of patients can go home with appropriate support.