This article emphasises the need for effective interdisciplinary and interagency communication to ensure a satisfactory transfer of care between hospital and the community. The author highlights some of the policies and guidelines which inform current practice, and examines some of the reasons why care is often fragmented in this important area for patients and their relatives

Discharge planning has been described as a process aimed at attaining continuity of care (Armitage 1991). This process should ensure a prompt and well orchestrated discharge from acute care, and that adequate care is continued thereafter, whether in the patient's home or in residential or nursing accommodation (Audit Commission 1992a). Central to discharge planning is the belief that a smooth transition from hospital to home is as essential to the patient as a medical cure because unmet needs following discharge can undo most of the previous progress, and may even result in relapse (Ryan 1994).