Changing social policy and scarce resources affect the delivery of health and social services. Higher costs mean shorter stays in hospitals. People are being discharged 'quicker and sicker'. This paper considers discharge planning policies and practices in America, in relation to a recent study on hospital social work in Madison, Wisconsin. It supports the view that discharge planning is a highly skilled activity, integral to social work and best done by qualified, trained workers. Such findings have relevance for Britain, where demands for cost effectiveness in the managemennt of care has raised the profile of discharge planning. In processing these changes, social workers are having to redefine their role in health care.