Job summary
We are looking for an enthusiastic and proactive candidate to support and coordinate discharge related tasks for designated wards in a safe and timely manner. You will be working closely with the multidisciplinary team (MDT), including nursing, medical, therapy, various social services partners, care agencies, community teams, Integrated care board, Transfer of care hub, D/C leads at UHS and other acute trusts, voluntary agencies, next of kin and other external partners. You will be supported by the AHP clinical lead in facilitating patient flow from our inpatients rehabilitation wards to the community. You will manage your own discharge related caseload of patients for delegated area of responsibility and commencing discharge planning discussions with MDT from day one of admission/ as soon as possible after admission. Along with the MDT you will provide assurance and ensure all patients have a planned discharge date, realistic discharge plans and take action to implement, monitor and amend the plans if necessary.
Only open to applicants from Hampshire & Isle of Wight NHS system, which is limited to: Hampshire and Isle of Wight ICB, Hampshire & Isle of Wight Healthcare FT, Portsmouth Hospitals University NHS Trust, University Hospital Southampton FT, South Central Ambulance Service, Isle of Wight NHS FT or Hampshire Hospitals FT
Main duties of the job
Ensure discharges are lined up for the earliest opportunity each day, escalating to appropriate leads where discharges are at risk of failing.
Maintain up to date information of the patients discharge planning on the appropriate database eg System 1, TOCH tracker etc
Attend daily board rounds on allocated wards to act as discharge key worker ensuring all discharge related tasks are actioned
Identify next of kin and / or significant family member to support patients discharge plans.
Provide patients and next of kin with discharge planning information including relevant part of Managing Complex Discharge Policy for the Trust.
Take ownership of the no Criteria to reside (NCtR) notification and reporting process for the ward area on System 1 and other relevant database as required.
Assist in delivering patient medication and equipment as required
Support patient flow and proactively reduce in length of stay and delayed discharges in the inpatient wards by leading on all aspects of discharge planning and escalate to AHP clinical lead, TOCH and ward managers any issues with complex discharge.
Liaise with care agencies and care homes to establish dates for assessments and agree transfer dates, work alongside social services, ICBs and trusted assessors to ensure return to placement and restarts of care packages are completed following policy
About us
Hampshire and Isle of Wight Healthcare NHS Foundation Trust is a newly established organisation, bringing together expertise from across mental health, learning disabilities, community, and physical health services. We are dedicated to delivering compassionate, high-quality, and accessible care to the diverse communities of Hampshire and the Isle of Wight.
With over 13,000 dedicated staff working across more than 300 sites, we place patients and staff at the centre of everything we do. Our goal is to create an integrated healthcare system that improves accessibility and ensures more consistent care for patients. By working together, we aim to improve patient outcomes, drive innovation, and meet the unique needs of the populations we serve.
Our Trust unites services from Southern Health, Solent NHS Trust, Isle of Wight NHS Trusts community and mental health teams, as well as Hampshire CAMHS, originally part of Sussex Partnership NHS Foundation Trust. This transformation enables us to deliver more seamless care across the region, ensuring that patients receive the right support, in the right place, at the right time.
Join us as we embark on this exciting journey to shape the future of healthcare across Hampshire and the Isle of Wight. We are deeply committed to our CARE values of compassion, accountability, respect, and excellence, and offer outstanding opportunities for career development, training, and collaborative working.
Job description
Job responsibilities
Further information about the Trust and this role can be found on the Job Description and Person Specification document attached. It is important to us that we ensure our recruitment processes are accessible and inclusive to everyone - if as a potential candidate you are concerned a person specification may prevent or restrict your application for employment as a result of unintentional barriers on the grounds of your sex, race, age, sexual orientation, religion/belief or disability please initially contact the Trust's Recruitment team - detailed in the advert. The Trust will seek to resolve this issue wherever possible.
We are happy to talk Flexible Working - all requests for flexible working options can be discussed as part of the interview process.
Job description
Job responsibilities
Further information about the Trust and this role can be found on the Job Description and Person Specification document attached. It is important to us that we ensure our recruitment processes are accessible and inclusive to everyone - if as a potential candidate you are concerned a person specification may prevent or restrict your application for employment as a result of unintentional barriers on the grounds of your sex, race, age, sexual orientation, religion/belief or disability please initially contact the Trust's Recruitment team - detailed in the advert. The Trust will seek to resolve this issue wherever possible.
We are happy to talk Flexible Working - all requests for flexible working options can be discussed as part of the interview process.
Person Specification
Qualifications
Essential
- 1. Clinical and Professional
- The suitable candidate is required to have a professional attitude and be able to demonstrate their ability to work as part of the multi-professional team and as an individual.
- Candidate must have effective communication and organisational skills and demonstrate the Trusts Value and behaviours at all times.
- Required to demonstrate information technology skills and be able to be flexible to meet the service need.
- Identify need for completion of relevant referral or assessment paperwork and liaise with appropriate team members to aid timely submission, e.g., onward care referrals, bridging care paperwork etc.
- 2. Communication / Education
- The Discharge Coordinator works in close conjunction with therapy and nursing staff to progress the patients pathway through the inpatient wards to expedite their discharge.
- The role will include effective communication with the discharge team and external health and social care agencies, the completion of relevant referrals, ensuring discharge summaries are written, collecting medication from pharmacy and active involvement in the daily rounds.
- To provide discharge planning expertise to patients, relatives, carers and or representatives during the patients stay.
- Provide discharge planning education and training to ward-based staff.
- In compliance with the Trusts practices and procedures associated with the control of infection, you are required to:
- Adhere to Trust Infection Control Policies, assuring compliance with defined infection control standards at all times.
- Conduct hand hygiene in accordance with Trust Policy, challenging those around you that do not.
- Challenge poor practice that could lead to transmission of infection.
- 3. Management and Leadership
- The post holder to ensure they work within professional boundaries
- Staff are managed and standards of work are maintained and trust policies for the management of staff performance are adhered too.
- Appraisals of staff directly managed are undertaken and that the appraisal process is maintained throughout the team.
- Provide leadership role model and demonstrate specialist knowledge and high standards of clinical practice
- Manage staff sickness absence according to policies set out locally
- Co-ordinate day to day management of the clinical area
- Participate in recruitment of other healthcare professionals where appropriate
- Staff receive appropriate health and safety and other mandatory training as prescribed, and those relevant records are maintained
- Appropriate risk and other assessment are completed and documented in a timely manner in accordance with trust policy
- 4. Performance
- Administrate System 1 and other database to identify patients activity in discharge planning process and highlighting delays in the system e.g. NCtR, red and green tool etc.
- Maintain accurate patient record keeping including documentation in System 1, R-drive etc and participate as needed in the collation of statistics demonstrating impact on service delivery.
- Maintain standards for discharge in conjunction with other members of the multi-disciplinary team.
Person Specification
Qualifications
Essential
- 1. Clinical and Professional
- The suitable candidate is required to have a professional attitude and be able to demonstrate their ability to work as part of the multi-professional team and as an individual.
- Candidate must have effective communication and organisational skills and demonstrate the Trusts Value and behaviours at all times.
- Required to demonstrate information technology skills and be able to be flexible to meet the service need.
- Identify need for completion of relevant referral or assessment paperwork and liaise with appropriate team members to aid timely submission, e.g., onward care referrals, bridging care paperwork etc.
- 2. Communication / Education
- The Discharge Coordinator works in close conjunction with therapy and nursing staff to progress the patients pathway through the inpatient wards to expedite their discharge.
- The role will include effective communication with the discharge team and external health and social care agencies, the completion of relevant referrals, ensuring discharge summaries are written, collecting medication from pharmacy and active involvement in the daily rounds.
- To provide discharge planning expertise to patients, relatives, carers and or representatives during the patients stay.
- Provide discharge planning education and training to ward-based staff.
- In compliance with the Trusts practices and procedures associated with the control of infection, you are required to:
- Adhere to Trust Infection Control Policies, assuring compliance with defined infection control standards at all times.
- Conduct hand hygiene in accordance with Trust Policy, challenging those around you that do not.
- Challenge poor practice that could lead to transmission of infection.
- 3. Management and Leadership
- The post holder to ensure they work within professional boundaries
- Staff are managed and standards of work are maintained and trust policies for the management of staff performance are adhered too.
- Appraisals of staff directly managed are undertaken and that the appraisal process is maintained throughout the team.
- Provide leadership role model and demonstrate specialist knowledge and high standards of clinical practice
- Manage staff sickness absence according to policies set out locally
- Co-ordinate day to day management of the clinical area
- Participate in recruitment of other healthcare professionals where appropriate
- Staff receive appropriate health and safety and other mandatory training as prescribed, and those relevant records are maintained
- Appropriate risk and other assessment are completed and documented in a timely manner in accordance with trust policy
- 4. Performance
- Administrate System 1 and other database to identify patients activity in discharge planning process and highlighting delays in the system e.g. NCtR, red and green tool etc.
- Maintain accurate patient record keeping including documentation in System 1, R-drive etc and participate as needed in the collation of statistics demonstrating impact on service delivery.
- Maintain standards for discharge in conjunction with other members of the multi-disciplinary team.
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.
