Sirona care & health CIC

Community Transfer of Care Hub Case Manager

This job is now closed

Job summary

Are you a nurse or therapist looking for a community job in a developing service?

Do you have experience of supporting people with complex health and social care needs in the community?

United Hospitals Bristol and Weston Trust are launching two new Transfer of Care Hubs to support our patients with discharge planning from admission through leaving hospital and into the community: one Hub at the Bristol Site and one at Weston General Hospital. backgrounds.

The aim is to work collaboratively and holistically to support patients to get 'Home First' by co-locating a team of professionals from different organisations to streamline complex discharges. To have face to face conversations that facilitate partners working together to maximise opportunities for an early discharge that embraces positive risk taking and keeps the patient at the centre of everything that we do.

You will need to have experience working in the community setting and an understanding of the levels of clinical acuity that can be supported in peoples own homes. Alongside this you will have an understanding of rehabilitation pathways, discharge planning and mental capacity issues, excellent interpersonal and negotiation skills.

In return, we will provide you with regular training and supervision and enable you to become involved in future service developments.

We have currently have vacancies in Warmley and South Bristol.

Main duties of the job

Responsible for triaging referrals received by the Community Transfer of Care Hub (CToCH). This may include liaising with the patient, family/carers and ward staff to identify the most appropriate discharge pathway.

Support the CToCH to discuss complex cases with North Somerset Council to agree a joint action and discharge plan.

To utilise multi-disciplinary assessment skills, supported by sound clinical reasoning to facilitate timely hospital discharge to the most appropriate environment

To work collaboratively with partner organisations on a daily basis to develop patient-centred rehabilitation and reablement plans.

To be able to effectively triage and prioritise a large caseload and be able to adjust daily work plan in response to system-wide pressures and escalation. Pro-actively optimising the usage of community capacity on a daily basis.

High level of problem-solving required, gathering information from a range of sources, using professional experience and clinical knowledge to inform decision making. This includes being able to complete mental capacity assessments and make best interest decisions where appropriate.

Liaise with internal and external partners as well as members of the public on a daily basis.

The role has a direct impact in maximising flow into community beds and Pathway 1 services, expediting hospital discharges and reducing the length of time patients are in hospital.

The Service currently operates 7 days a week 08:00 18:00.

About us

We are Sirona care & health, a Community Interest Company committed to providing local communities with a range of high-quality specialist health care services across Bristol, North Somerset and South Gloucestershire. For us, its about the personal approach; we take pride in what we do and deliver the high standard of care that we would expect for ourselves and our families.

At Sirona, we continue to build an inclusive culture that encourages, supports, and celebrates the diverse voices of colleagues, service users and communities. We therefore welcome applications from all those who feel they have the skills and attributes we are seeking.

Benefits:

We offer NHS Agenda for Change Salary, Terms and Conditions and an NHS pension scheme plus much more! Please see the benefits leaflet attached to this advert for more details.

Additional Information:

Please note that we reserve the right to close this vacancy early if sufficient applications are received prior to the advertised closing date.

Date posted

24 August 2023

Pay scheme

Agenda for change

Band

Band 6

Salary

£35,392 to £42,618 a year pro rata

Contract

Permanent

Working pattern

Full-time, Flexible working

Reference number

B9083-23-0265b

Job locations

South Bristol Community Hospital

Hengrove Promenade

Bristol

BS140DE

Warmley Business Park

Units 1 and 2

Warmley

BS308Xl

Job description

Job responsibilities

Please see the attached job description and person specification for further information about the role.

If you have any questions please contact:

Karen Keemer Sirona Community Transfer of Care Hub Service Lead 07810630112

Job description

Job responsibilities

Please see the attached job description and person specification for further information about the role.

If you have any questions please contact:

Karen Keemer Sirona Community Transfer of Care Hub Service Lead 07810630112

Person Specification

Qualifications

Essential

Professional Qualification in Nursing, Occupational Therapy or Physiotherapy.
Registered with HCPC or RCN

Experience

Essential

Able to work across professional and organisational boundaries recognising when there are barriers to partnership working and able to implement solutions to overcome these.
The ability to interpret clinical information, use analytical and problem-solving skills to inform decision making.
Able to demonstrate innovative practice.
Ability to coordinate and manage a caseload including prioritising the workload, appropriate use of escalation plan, time management and delegation.
Ability to present complex information at meetings or case conferences. When required to be able to present information to the CCG to support the requirement of additional funding (e.g., 1-1 support) to enable a hospital discharge.
Ability to complete mental capacity assessments when required and if the patient lacks capacity act as the lead for making a best interest decision as part of a multi-disciplinary team.
A competent level of IT skills including user knowledge of core Microsoft Office packages and electronic patient records.

Desirable

Ability to present self and service in a professional manner promoting the service at all times.
Experience of working within hospital and community settings.
Ability to build, and maintain, effective working relationships at all levels.

Person Specification

Qualifications

Essential

Professional Qualification in Nursing, Occupational Therapy or Physiotherapy.
Registered with HCPC or RCN

Experience

Essential

Able to work across professional and organisational boundaries recognising when there are barriers to partnership working and able to implement solutions to overcome these.
The ability to interpret clinical information, use analytical and problem-solving skills to inform decision making.
Able to demonstrate innovative practice.
Ability to coordinate and manage a caseload including prioritising the workload, appropriate use of escalation plan, time management and delegation.
Ability to present complex information at meetings or case conferences. When required to be able to present information to the CCG to support the requirement of additional funding (e.g., 1-1 support) to enable a hospital discharge.
Ability to complete mental capacity assessments when required and if the patient lacks capacity act as the lead for making a best interest decision as part of a multi-disciplinary team.
A competent level of IT skills including user knowledge of core Microsoft Office packages and electronic patient records.

Desirable

Ability to present self and service in a professional manner promoting the service at all times.
Experience of working within hospital and community settings.
Ability to build, and maintain, effective working relationships at all levels.

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Additional information

Disclosure and Barring Service Check

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Employer details

Employer name

Sirona care & health CIC

Address

South Bristol Community Hospital

Hengrove Promenade

Bristol

BS140DE

Employer's website

https://www.sirona-cic.org.uk/ (Opens in a new tab)

Employer details

Employer name

Sirona care & health CIC

Address

South Bristol Community Hospital

Hengrove Promenade

Bristol

BS140DE

Employer's website

https://www.sirona-cic.org.uk/ (Opens in a new tab)