The hospital has told you your relative is medically fit for discharge. That sentence triggers a legal process called Discharge to Assess (D2A). Here is the 48 to 72 hour plan.
The short answer. Medically fit for discharge means the ward team can no longer treat the acute issue, but it does not mean the patient is safe to go home today. The legal route is Discharge to Assess (D2A). The NHS funds up to 6 weeks of bed-based or home-based reablement while a long-term plan is set. Ask the discharge coordinator which D2A pathway is planned, and request a CHC Fast Track if the patient is rapidly deteriorating.
What "medically fit" actually means
Medically fit (now usually called medically optimised) is a hospital decision about acute care, not about social need. The Hospital Discharge and Community Support Guidance from the Department of Health and Social Care sets the framework. DHSC guidance ↗
Once that decision is made, the discharge clock starts. NHS England expects most discharges to move within 24 to 48 hours of the medically optimised decision. NHS England D2A ↗
The 48-72 hour timeline
Hour 0
Hospital team writes medically optimised. Discharge coordinator notified.
Hour 6-12
Ward nurse and discharge coordinator confirm pathway: D2A 1 (home), 2 (reablement bed), 3 (24hr bed).
Hour 24
NHS commissions the placement. Family asked for preferences but cannot block a safe option.
Hour 48
Bed identified. If no bed, escalate to the discharge team manager and on-call commissioner.
Hour 72
Transfer happens. Assessment window opens, usually up to 6 weeks.
Week 6
Long-term plan set. Means test starts if patient is self-funded.
Which pathway will be chosen
Discharge to Assess has four named pathways. Pathway 0 is straight home with no extra support and rarely applies in a crisis. The relevant three in an emergency are:
- Pathway 1 - home with reablement.
- Pathway 2 - bed-based reablement in a care home or community unit.
- Pathway 3 - bed-based 24-hour care with assessment for long-term placement.
Who pays for the first 6 weeks
First 72 hours
NHS-funded under D2A. No charge to the patient or family.
Weeks 1-6 (reablement)
NHS-funded while assessment runs. No means test in this window.
After week 6 (LA-funded)
Council pays the contract rate if savings under £23,250 (England 2026/27).
After week 6 (self-funded)
Family pays full rate, £900 to £1,800 per week residential, £1,300 to £2,100 nursing.
Top-up
Family pays the difference if a preferred home costs more than the council rate.
What if no bed is found in 72 hours
The patient does not have to leave hospital until a safe destination is identified. The legal duty is on the NHS and the council to keep the placement search going. Escalate, in this order: discharge coordinator, ward sister, discharge team manager, integrated care board (ICB) on-call commissioner. NICE NG27 ↗
Frequently asked
Can the hospital force discharge with nowhere safe to go?
No. Discharge has to be to a safe destination. If a placement is not yet found, the duty is on the trust and council to keep searching. You can ask for a copy of the D2A pathway decision in writing.
Who pays for a care home bed during D2A?
The NHS, in full, for up to 6 weeks while assessment runs. After week 6 it switches to a means-tested arrangement unless CHC Fast Track is signed.
What if we want a different home from the one offered?
You can ask, but you cannot block a safe option indefinitely. If your preferred home costs more than the council rate, a third-party top-up may be needed. See top-up fees.
Can a CHC Fast Track override D2A?
Yes. If a senior clinician signs a Fast Track Pathway Tool, the NHS funds the care in full and the placement search is led by the CHC team, not the council.
Last reviewed 2026-06-21. Clinical reviewer pending appointment (target Sep 2026); meanwhile reviewed by the editorial team.