Neuro Navigator

Job description

Job responsibilities

To be an integral member of the *community rehabilitation team with responsibility for supporting patients with a Newham registeredGP with complex neuro rehabilitation needs as they move from acute services through to in-patient services and into community services.

To work in partnership with acute services, specialist neurological rehabilitation services, local rehabilitation and community services in identifying the most appropriate patient pathway utilising level 1, 2a, 2b and community provision.

To signpost and support the referral process for specialist neuro rehabilitation admissions (level 1, 2b).

Use clinical expertise and system knowledge to identify and recommend appropriate spot purchase neuro rehabilitation admissions as required. Providing brokerage and monitoring of the admission as appropriate.

To demonstrate highly developed therapy skills, assisting and enabling staff to assess, plan, implement and evaluate care; integrating therapy interventions in community care packages, as well as assisting to identify if inpatient rehab as appropriate.

To minimise unnecessary waits within the rehabilitation system, supporting acute teams and rehab providers to communicate up to date and relevant information.

To provide expert advice and signposting to the local neuro rehabilitation system.

To work directly with clients and other health care professionals in a facilitative and supportive role in issues surrounding therapy interventions.

Working within varied and sometimes challenging socio-economic environments with clients and their families who may face complex social problems and who, as a group, come from culturally diverse background (some are unable to speak English).

To support the teams to ensure timely discharge and avoid delayed transfers of care ensuring discharge planning is co-ordinated with local resources and local knowledge avoiding delays to planned discharge.

To attend case conferences and review meetings at specialist neuro-rehabilitation units and spot purchase beds to support individual pathways through complex specialist rehabilitation.

*Support acute and rehabilitation services in the completion of CHC and associated paperwork and support the transference over to CHC if required for long term placement.

To ensure that the most appropriate placement is identified on discharge from rehabilitation providers.

To support the discharge plan to placement/ home. Ensuring the transition of rehab goal achievement, care plans, therapeutic care requirements e.g. wheelchairs, specialist seating, communication aids, cognitive strategies into the new placements and specialist adaptive equipment.

To communicate with service users, their families and carers empowering them to make informed choices with their rehabilitation needs along the pathway and support the management of expectations in the move to long term placement if appropriate.

*To support complex discharges into the community including liaison with housing services, community services and ensuring that individuals complex needs are met.

*Coordinate capacity and best interest assessments, court of protection applications and financial issues as identified e.g. termination of tenancy if indicated.

*To provide ongoing further complex case management for those patients following admission to a complex Neuro-rehabilitation setting if identified as required.

*To identify changing clinical needs and the impact upon placement tariffs, identifying non-eligibility to CHC and supporting individuals returning to borough and reducing care dependency e.g. moving people from a nursing home to living in the community.

*To support maintenance care plans for individuals with complex neurological conditions e.g. unplanned change in support workers, problem solving adhoc issues e.g. transport to Headway day centre.

*Provide a case management approach for complex patients, acting as a central point of contact for the multidisciplinary team and families.

• To ensure the timely completion/uploading of accurate documentation and therapy reports
• To input and maintain own statistical data on a regular basis in accordance with local and NEL data requirements.
• Be able to independently use computer systems to facilitate client care.
• To report quarterly on Neuro rehab data to the Neuro Navigator group and commissioning,

• To provide expert therapy advice acting as a resource to community teams, other provider services / agencies and providing support internally and externally to the organisation.
• To contribute to clinical excellence across Trust-based, regional and local/London-based neurorehabilitation services by taking part in relevant clinical and professional activities and networks.
• Provide detailed and data driven assessment of the local and regional neuro rehab system to the ICB and wider neuro rehab system.

To take a role in supporting neurological rehabilitation networks and professional forums in accordance with local national strategies and guidance.

• Set a high personal standard of practice and maintain up to date knowledge of clinical professional developments in the field of complex neurological impairment, neurological rehabilitation and post holders professional background and incorporate appropriately into clinical practice.
• *Be responsible for the clinical supervision, development and appraisal of staff within the CRT or services along the pathway which will include the use of formal appraisal documentation.
• To be an active member of the London Neuro-navigator forum.

1. Education and Training

The postholder will have access to, and is expected to participate in, a range of training and support activities, both for his/her own development and for that of colleagues and other professionals. In particular, s/he is expected to:

Identify needs for, develop, and implement education and training events (presentations, workshops etc) concerned with the assessment, treatment, and management of patients with complex neurological disability living in the community. These events are aimed mainly at other specialists within this clinical area.

2. Reporting KPIS relevant to Neuro Navigator

1. Brokerage

The post holder will secure placements funding, liaising with ICB.

Will review placements , ensuring cost and clinical effectiveness .

Person Specification

Education/ Qualification/ Training

Essential

• Professional degree / diploma in physiotherapy / occupational therapy / nursing
• HCPC registration / NMC registration

Experience

Essential

• Extensive experience, expertise and understanding of neuro-rehabilitation systems, services and interdependencies
• Experience of multi-agency working that spans organisational boundaries and the patient pathway
• Teaching / training of undergraduate / postgraduate/staff and other professionals
• Experience of clinically leading a team
• Establishing or developing clinical standards/pathways
• Use of outcome measures
• Experience of planning and delivering clinical supervision/mentoring to peers and nonqualified staff

Knowledge and Skills

Essential

• Strong interpersonal skills with ability to relate to and work with diverse multi
• Organisational and multi-disciplinary teams
• Excellent communication skills with the ability to translate complex clinical information into clear explanations for patients and families
• Strong influencing and diplomacy skills to ensure the views of the patient and family are represented in clinical decision making
• Excellent practical problem solving and decision making skills
• Ability to manage competing priorities and organise time effectively
• Ability to rapidly build credibility and good working relationships with clinicians, patients/families and all other stakeholders earning their trust and confidence
• Ability to analyse and organize complex information and situations
• Possess the drive to maintain momentum despite obstacles
• Be confident working independently, while also able to draw on wider support
• Strong presentation and writing skills
• Expert knowledge of current guidelines and national standards that relate to neurorehabilitation
• Expert knowledge of rehabilitation principles in assessment and treatment
• Understanding of current NHS and local / national policies and clinical governance Flexible and open to change
• Ability to work under pressure
• Initiative, enthusiasm and motivation of self and others
• Confidence and assertiveness in a challenging environment

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.

Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).

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

East London NHS Foundation Trust

Address

Community Neuro Service, , East Ham Care Centre

Shrewsbury Road

Forest Gate

E7 8QP

Employer's website

https://www.elft.nhs.uk/ (Opens in a new tab)