The number of patients discharged from hospital who need home enteral tube feeding has been increasing steadily in the UK. Arrangements for support of these patients is extremely variable. The unsatisfactory arrangements for home enteral tube feeding which existed in Avon in 1996 prompted an innovative reorganization. On the basis of that experience, this review examines the key issues involved and the questions to be considered, which may be of benefit to other trusts faced with similar challenges.