Job summary
The Transition Social Worker role requires excellent interpersonal and leadership skills to support both the Acute Mental Health Service Line and the broader community. The primary focus is to reduce readmissions by ensuring a smooth transition from admission to discharge and providing ongoing support to high-risk patients in the community.
The purpose of a Transition Social Worker in Adult Social Care is to complete assessments, including those mandated by the Care Act 2014, and to enhance the well-being of eligible individuals. In addition to adhering to the practice standards set by Social Work England (SWE), Transition Social Workers must apply a wide range of knowledge and skills to build relationships and work directly with individuals, their families, and carers in a strengths-based way, empowering them to achieve the best outcomes.
The role involves working proactively to identify patients at high risk of readmission and developing tailored discharge plans to address their specific needs. The Transition Social Worker will collaborate closely with both Acute Mental Health Units and community teams to overcome barriers to discharge, ensuring patients receive the necessary support to thrive outside the hospital.
Main duties of the job
oTo work within the regulation of the Care Act 2014 and other relevant statutory frameworks.
oTo apply Social Work principles and values to professional practice and to emulate our corporate values in all interactions with patients, colleagues, and partners.
oTo effectively manage a reasonable caseload appropriate to the level of experience and to maintain adequate throughput of work. To discuss any challenges with caseload management with your line manager in a timely way to access any necessary support with prioritisation.
oTo provide support and expert advice on social care to social assessors, students, and partners.
oTo be professionally curious when undertaking effective assessments of individual and carer needs and risks within statutory frameworks, using a strengths-based, person-centred approach to ensure they are focused on outcomes. This includes promoting a holistic, multi-agency approach by developing and maintaining collaborative working relationships.
About us
West London NHS Trust is one of the most diverse healthcare providers in the UK, delivering a range of mental health and physical healthcare and community services. The Trust runs Broadmoor Hospital, one of three high secure hospitals in the country, with an international reputation.
Our high secure services care for patients from South of England and we provide low and medium secure services across eight London boroughs. The Trust also provides mental and physical healthcare in three London boroughs (Ealing, Hounslow and Hammersmith & Fulham). We employ over 5,000 staff, of whom 59% are BME. Our turnover for 2024-25 is over £500m.
The Trust is rated as 'Good' overallby the Care Quality Commission. Forensic services are rated as 'Outstanding'.
The Trust is an established partner and contributor in the development of the evolving North West London Integrated Care System and the Integrated Care Board. The Trust leads the NW London Children and Adolescent Mental Health provider collaborative.
Job description
Job responsibilities
The Candidate Pack provides an overview of the key tasks and responsibilities of the role, and the person specification outlines the qualifications, skills, experience and knowledge required. Please view as attached
The person specification below is not the full person specification, but outlines the criteria against which your application form will be assessed.
Job description
Job responsibilities
The Candidate Pack provides an overview of the key tasks and responsibilities of the role, and the person specification outlines the qualifications, skills, experience and knowledge required. Please view as attached
The person specification below is not the full person specification, but outlines the criteria against which your application form will be assessed.
Person Specification
Qualifications and Training
Essential
- Current professional registration in relevant clinical subject/practice e.g. Social Work,
- Evidence of post qualification training/education.
- Ongoing evidence of continuing professional development.
- A commitment to completing full quality
- improvement development as outlined in the trust strategy
Desirable
- Training in providing supervision, mentorship or equivalent, or willingness to undertake training.
- Post Graduate degree (in relevant subject).
- To have completed or be working towards accredited courses which enable potential development
- Recognised training that supports clinical practice (Psychosocial Intervention or DBT)
Experience
Essential
- Demonstrable experience of working at Band 5 or equivalent for 2 years.
- Experience of liaising with community agencies.
- Experience of working with people who have experienced serious ongoing mental health problems.
- Experience of working within a multidisciplinary team.
- Experience of conducting effective assessments including of risk.
- Experience of developing care and support plans that deliver personalised, integrated care and support that helps people to maintain their independence and attain the outcomes they want
- Experience of working collaboratively with patients, their families and other professionals
- Experience of making effective decisions that make best use of available resources to meet eligible needs and achieve outcomes.
- Experience of implementing the principles and practice of the Recovery approach
Desirable
- Experience of implementing changes in working practices
- Experience of using and supervising others in the use of psychosocial interventions
- Experience of using quality improvement methodologies
- Experience of implementing and monitoring standards of care, including clinical audit and governance
Knowledge
Essential
- Sound knowledge and skills in risk assessment
- Knowledge of safeguarding policies and procedures
- Clear understanding of the Mental Health Act, Care Act, Housing Act, Quality & Safety Governance, Clinical audit and relevant national policies
- Knowledge of recent initiatives across professional workforce
- Clear understanding of the process of Supervision
Desirable
- Ability to contribute to, monitor and implement changes and improvements to services
- Familiarity with budget control and management
- Ability to monitor and control resources
- Knowledge of performance management procedures
- Ability to think creatively about opportunities for practice development
- Appreciation of the ward/team manager's role and how to balance clinical and non-clinical responsibilities
- Knowledge of Recovery Model of care
- Ability to work within a Team
Skills
Essential
- Ability to maintain Social Work Professional Standards
- Ability to model and encourage our Corporate values and behaviours and to be positive, open-minded, supportive and respectful to colleagues, partners and residents
- Ability to communicate effectively with others and ability to write a clear, accurate, consistent and timely and case record and reports as per the Recording Guidance
- The ability to effectively manage time effectively, including adequate throughput of casework, learning and other team requirements
- The ability to effectively use supervision to support caseload management, raise risks and ask advice, reflect on practice and contribute towards development of core skills and competence
- To be technically proficient and able to use IT equipment, able to demonstrate digital solutions for residents and carers and understand pertinent data
Desirable
- Specialised clinical skills, e.g. group work, anxiety/anger management, CBT, family work skills
Other Requirements
Essential
- Ability to reflect, identify and take responsibility for continuing professional development needs
- Understand the need for and actively participates in own supervision and constructive use of feedback
- High levels of initiative, innovation and self-motivation.
- Commitment to client-centred, non-discriminatory practice.
Desirable
- Able to demonstrate a strong professional identity.
Person Specification
Qualifications and Training
Essential
- Current professional registration in relevant clinical subject/practice e.g. Social Work,
- Evidence of post qualification training/education.
- Ongoing evidence of continuing professional development.
- A commitment to completing full quality
- improvement development as outlined in the trust strategy
Desirable
- Training in providing supervision, mentorship or equivalent, or willingness to undertake training.
- Post Graduate degree (in relevant subject).
- To have completed or be working towards accredited courses which enable potential development
- Recognised training that supports clinical practice (Psychosocial Intervention or DBT)
Experience
Essential
- Demonstrable experience of working at Band 5 or equivalent for 2 years.
- Experience of liaising with community agencies.
- Experience of working with people who have experienced serious ongoing mental health problems.
- Experience of working within a multidisciplinary team.
- Experience of conducting effective assessments including of risk.
- Experience of developing care and support plans that deliver personalised, integrated care and support that helps people to maintain their independence and attain the outcomes they want
- Experience of working collaboratively with patients, their families and other professionals
- Experience of making effective decisions that make best use of available resources to meet eligible needs and achieve outcomes.
- Experience of implementing the principles and practice of the Recovery approach
Desirable
- Experience of implementing changes in working practices
- Experience of using and supervising others in the use of psychosocial interventions
- Experience of using quality improvement methodologies
- Experience of implementing and monitoring standards of care, including clinical audit and governance
Knowledge
Essential
- Sound knowledge and skills in risk assessment
- Knowledge of safeguarding policies and procedures
- Clear understanding of the Mental Health Act, Care Act, Housing Act, Quality & Safety Governance, Clinical audit and relevant national policies
- Knowledge of recent initiatives across professional workforce
- Clear understanding of the process of Supervision
Desirable
- Ability to contribute to, monitor and implement changes and improvements to services
- Familiarity with budget control and management
- Ability to monitor and control resources
- Knowledge of performance management procedures
- Ability to think creatively about opportunities for practice development
- Appreciation of the ward/team manager's role and how to balance clinical and non-clinical responsibilities
- Knowledge of Recovery Model of care
- Ability to work within a Team
Skills
Essential
- Ability to maintain Social Work Professional Standards
- Ability to model and encourage our Corporate values and behaviours and to be positive, open-minded, supportive and respectful to colleagues, partners and residents
- Ability to communicate effectively with others and ability to write a clear, accurate, consistent and timely and case record and reports as per the Recording Guidance
- The ability to effectively manage time effectively, including adequate throughput of casework, learning and other team requirements
- The ability to effectively use supervision to support caseload management, raise risks and ask advice, reflect on practice and contribute towards development of core skills and competence
- To be technically proficient and able to use IT equipment, able to demonstrate digital solutions for residents and carers and understand pertinent data
Desirable
- Specialised clinical skills, e.g. group work, anxiety/anger management, CBT, family work skills
Other Requirements
Essential
- Ability to reflect, identify and take responsibility for continuing professional development needs
- Understand the need for and actively participates in own supervision and constructive use of feedback
- High levels of initiative, innovation and self-motivation.
- Commitment to client-centred, non-discriminatory practice.
Desirable
- Able to demonstrate a strong professional identity.
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
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).
