Job summary
We are seeking an organised, proactive, and patient-centred Discharge Care Co-Ordinator to join our team at Frimley Health NHS Foundation Trust. This pivotal role supports the safe, timely, and effective discharge of patients from hospital settings. Working closely with the multi-disciplinary team (MDT), the post-holder will co-ordinate discharge planning processes, support communication with families and community services, and ensure discharge arrangements are in place and progressing efficiently.
This is a ward-based role, typically assigned to a named ward or group of wards. However, the post-holder will be required to provide cross-site support and flexible cover at times of operational demand, across Wexham Park, Heatherwood, and Frimley Park Hospitals.
Main duties of the job
- As part of an integrated Capacity and Discharge Team to work in partnership with social services and external stake holders, patients and their carers to proactively support and facilitate timely and safe discharge from hospital to home or onward care settings.
- To provide a single point of contact on a named ward for patients, families, carers and associated people and co-ordinate/contribute to the safe and timely hospital discharge in partnership with other multi-disciplinary colleagues.
- Maintain momentum of discharge planning throughout the entire process; supporting and working in partnership with other members of the MDT; doctors, nurses , occupational therapists , physiotherapists and other Hospital Assessment and Discharge Team members and constructively challenging where appropriate decisions with regards to discharge planning.
About us
Frimley Health NHS Foundation Trust is committed to being an inclusive and disability confident employer and has been awarded the Gold for the Armed Forces Employment Recognition Scheme. We provide first class development opportunities for all staff and have a wide range of professional, management and leadership, and clinical skills training available.
Here at Frimley Health NHS Foundation Trust, we know how important it is to have a healthy work life balance; this benefits not only individuals but the patients we care for too.
We encourage applications from people who wish to work on a flexible basis, recognising that flexibility may mean a range of different working patterns and hours, we do our utmost to work with our staff to meet their needs and the needs of our service and its users.
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Job description
Job responsibilities
- To screen all patients on admission and identify those who will require further social care assessment and input; complete the appropriate referral documentation and/or input directly to the relevant IT system to activate a referral or re-referral.
- To undertake baseline assessment in partnership with other members of the MDT, the patient and their carer and commission simple services on behalf of the patient and/or their carer.
- To promote the delivery of personalised care within the acute environment, promoting independence and enabling the individual to take control of their life.
For more information please see the attached job description and person specification.
Job description
Job responsibilities
- To screen all patients on admission and identify those who will require further social care assessment and input; complete the appropriate referral documentation and/or input directly to the relevant IT system to activate a referral or re-referral.
- To undertake baseline assessment in partnership with other members of the MDT, the patient and their carer and commission simple services on behalf of the patient and/or their carer.
- To promote the delivery of personalised care within the acute environment, promoting independence and enabling the individual to take control of their life.
For more information please see the attached job description and person specification.
Person Specification
Qualifications
Essential
- Evidence of current CPD including evidence of recent study at least to NVQ Level 3
- NVQ 3 & GCSC
- Willingness and commitment to complete NVQ Level 4 in Health and Social Care within 2 years of appointment
Experience
Essential
- Recent experience of working in a health or social care setting
- Experience of adapting own approach to engage with service users with a wide variety of needs
- Experience of working with service users with a wide range of disabilities and clinical conditions
Desirable
- Experience as a HSCC or CCW (or comparable health role)
- Experience of previous hospital or community working
- Experience of completing care plans
- Experience of teaching/training
Skills & Knowledge
Essential
- Experience of health and/or social care IT systems
- Experience completing patient related documentation
- Knowledge of Single Assessment Processes (SAP) and documentation
- Knowledge of targets and performance indicators affecting health and social care organisations
Desirable
- Knowledge of legislation and policy that has shaped current health and social care provision e.g. Community Care Act; Disability discrimination Act; Your health Your Care Your Say
Person Specification
Qualifications
Essential
- Evidence of current CPD including evidence of recent study at least to NVQ Level 3
- NVQ 3 & GCSC
- Willingness and commitment to complete NVQ Level 4 in Health and Social Care within 2 years of appointment
Experience
Essential
- Recent experience of working in a health or social care setting
- Experience of adapting own approach to engage with service users with a wide variety of needs
- Experience of working with service users with a wide range of disabilities and clinical conditions
Desirable
- Experience as a HSCC or CCW (or comparable health role)
- Experience of previous hospital or community working
- Experience of completing care plans
- Experience of teaching/training
Skills & Knowledge
Essential
- Experience of health and/or social care IT systems
- Experience completing patient related documentation
- Knowledge of Single Assessment Processes (SAP) and documentation
- Knowledge of targets and performance indicators affecting health and social care organisations
Desirable
- Knowledge of legislation and policy that has shaped current health and social care provision e.g. Community Care Act; Disability discrimination Act; Your health Your Care Your Say
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.
