"They said she was medically fit and someone would call about care. Nobody called. She came home in a taxi and I still had no idea what I was supposed to do."
This happens to carers constantly. In a recent survey, only 14% of carers said hospital staff asked whether they could actually cope with the care being planned. If that's you right now — here's what's actually meant to happen, and what to do if it isn't.
"Medically fit" doesn't mean "ready"
"Medically fit for discharge" just means the hospital doesn't need to treat them anymore. It does not mean anyone has worked out whether they can cope at home, or what help they'll need. Those are two separate decisions.
NHS hospitals are now moving to a model called Discharge to Assess. The idea is that most people recover better at home than on a ward — so instead of holding someone in hospital while a full care assessment is done, they're sent home (or to a short-term bed) first, with the detailed working-out of ongoing support happening afterwards, ideally in their own home. Done properly, this is meant to help people recover with dignity and less risk of the deconditioning, infection, and loss of independence that comes with staying in a hospital bed longer than needed.
The problem is when the "assess" half never properly happens — someone's sent home, and the promised call, care visit, or equipment just doesn't materialise. That's not Discharge to Assess working. That's a plan with a hole in it, and you're entitled to say so.
FIT
needed on the ward
by doctors
FOR HOME
with what support?
worked out
This gap — between "fit" and "ready" — is where most rushed discharges happen. It's also exactly where you're allowed to push back.
The four discharge pathways
You might hear staff mention a "pathway" number. This is just a shorthand for where someone is going and how much support they'll need — worth knowing so the conversation makes sense:
Most people are pathway 0 or 1. Pathway 3 (a brand-new care home placement) is meant to be rare and used only when long-term 24-hour care is genuinely needed — it should never be presented as the automatic next step just because a bed is available.
Ask now, while it's being set up: "What's the exact start date, and what happens on day 43?" Get both dates confirmed in writing. Don't wait for a reassessment letter to tell you it's ending — by then you've lost the time to plan for it.
What the hospital actually has to do
Carer involvement in discharge planning isn't just good practice — it's a statutory duty under the Health and Care Act 2022 (section 91). Where ongoing care or support is likely to be needed after discharge, the hospital is required to involve the patient and their carer as early as possible, not simply inform them of a decision already made.
In practice, that means the hospital should:
- ✅Involve youNot just tell you the plan — actually ask what you think, and involve you while the plan is still being made, not after.
- ✅Ask if you can copeBeing family doesn't mean you're able or willing to provide care. If caring responsibilities are new or have changed, you should be offered a referral for your own carer's assessment.
- ✅Offer you your own assessmentIf you'll be doing more caring, your own needs can be looked at too — separately from theirs.
- ✅Tell you what's in place, in writingWhat care is arranged, what equipment is coming, who to call if something goes wrong.
- ✅Check in afterwardsGood practice includes a follow-up call within 24 hours of discharge to confirm care arrangements are in place and medications are understood — ask for this if it isn't offered.
Want to know more about that assessment for yourself? See our free Carer's Assessment guide.
What to do today
Get the plan in writing
Ask for the discharge date, the pathway (0–3), and what happens after — by email or on paper, not just a verbal "it'll be fine."
Say if you can't cope with what's planned
This is your right under the Health and Care Act 2022, not you letting anyone down. It tells the hospital the plan isn't safe as it stands.
Check what's actually ready
Equipment, medication explained, care visits confirmed, and a number to call if things go wrong in the first two days.
If it still feels wrong, speak up before they leave
Ask for PALS (the hospital's patient support team) today. Put your concern in writing and keep a copy.
Expect a follow-up call — chase it if it doesn't come
Within 24 hours of getting home, hospital or community teams should ideally check in. If nobody calls and something feels wrong, don't wait — contact the ward, GP, or NHS 111.
Can you say no?
You can't personally be forced to provide care you've said you can't give. And a hospital isn't supposed to send someone home into an unsafe situation. But simply refusing rarely stops a discharge on its own — what works better is putting a clear, specific safety concern in writing (a missing carer visit, no equipment, no one able to help) and asking for it to be sorted first.
If it still feels unsafe
Work through these — most concerns get sorted at step one or two:
If they can't make this decision themselves
If your relative can't weigh up the decision — because of dementia, a brain injury, or similar — the hospital has to check this properly and, with the family, decide what's genuinely in their best interests. If no one holds Power of Attorney, everyday decisions can still be made in their interests, but it's worth sorting Power of Attorney as soon as you can. Our free LPA guide explains how.
Quick questions
- What does "Discharge to Assess" actually mean for us?It means the detailed care assessment happens after they're home, not before. That's meant to help, but it only works if the promised support actually turns up on time.
- What if there's no care ready on the day?Say so straight away, to the ward and to PALS. No care in place is a real reason to ask for more time.
- Can they discharge at night?NHS guidance says this should be avoided — support at home is much harder to reach after hours. Ask for morning instead.
- What if I already said yes and now I can't cope?You're allowed to change your mind. Call the council's social care team and ask for an urgent reassessment — of them, and of you.
- What's the difference between pathway 1 and pathway 3?Pathway 1 is home with some extra support, usually free for the first 6 weeks. Pathway 3 is a brand-new care home placement, only meant for exceptional, long-term 24-hour need — it shouldn't be suggested lightly.
Who to contact
PALS — ask any ward staff for your hospital's PALS team. Free, fast, on-the-spot help with concerns.
Carers UK — 0808 808 7777 (freephone, Mon–Fri 9am–6pm). Advice on discharge and assessments.
Healthwatch — healthwatch.co.uk. Free, independent complaints help.
NHS 111 — Call 111 for urgent medical worries after discharge.
Sources
- Carers UK, State of Caring 2025 — the 14% statistic on carers being asked about their ability to provide care. carersuk.org
- NHS England, Model discharge pathway (July 2026) — Discharge to Assess model, pathway 0–3 definitions, and the 24-hour post-discharge follow-up call. england.nhs.uk
- Health and Care Act 2022, section 91 — the statutory duty to involve patients and carers in discharge planning. legislation.gov.uk
- GOV.UK / NHS England, Hospital Discharge and Community Support Guidance — free reablement for up to 6 weeks, and advice against night-time discharge. gov.uk
- NHS.uk, Being discharged from hospital — discharge assessments, PALS, and advocacy support. nhs.uk
- Age UK, Factsheet 37 — Hospital discharge and recovery — assessment process and best-interests decisions. ageuk.org.uk