Important Sponsorship Information for this post: We are currently unable to offer a certificate of sponsorship for this post.
The post holder will work as a key member of the Flow and Discharge Team based within the acute inpatient services (working age adult and older peoples). The post holder will work collaboratively directly with the band 6 discharge coordinators as well as with the Patient Flow Hub, Senior Flow and Discharge Coordinators (SF&DC), inpatient wards (internal and external), crisis teams, relevant community teams / services, service users and their families, working in a targeted way to achieve the best pathway for inpatients on discharge with early identification of factors that would potentially delay timely discharge and impact on provision of appropriate aftercare.
The post holder will focus mainly on patients with barriers to discharge across all three boroughs who require specific targeted support to unblock barriers to discharge that does not require the input of a registered nurse. To sit organisationally within the Patient Flow services and be present on the inpatient wards working with an identified caseload to enable effective discharge planning. The postholder would be required to travel to other Trust sites to support the SFDC and discharge Coordinators (DCs)within the discharge planning process for patients where required.
Oxleas offers a wide range of NHS healthcare services to people in community and secure environment settings. Our services include community health care such as district nursing and speech and language therapy, care for people with learning disabilities and mental health care such as psychiatry, nursing and therapies. Our multidisciplinary teams look after people of all ages and we work in close partnership with other parts of the NHS, local councils and the voluntary sector and through our new provider collaboratives. Our 4,300 members of staff work in many different settings including hospitals, clinics, prisons, secure hospitals, children’s centres, schools and people’s homes.
We have over 125 sites in a variety of locations in the South of England. In London we operate within the Boroughs of Bexley, Bromley Greenwich and into Kent. We manage hospital sites including Queen Mary’s Hospital, Sidcup and Memorial Hospital, Woolwich, as well as the Bracton Centre, our medium secure unit for people with mental health needs. We are the largest NHS provider of prison health services providing healthcare to prisons within Devon, Dorset, Bristol, Wiltshire and Gloucestershire, Kent and South London. We are proud of the care we provide and our people.
Our purpose is to improve lives by providing the best possible care to our patients and their families. This is strengthened by our new values:
We’re Kind
We’re Fair
We Listen
We Care
Support ward team and discharge co-ordinator with patient flow tasks (Contacting relevant stakeholders etc)
Completion of the barriers to discharge form on Rio for newly admitted patients within 72 hours
Attend MDT meetings, CPA’s and bed management meetings for identified patients
Identifying issues with housing and benefits, offering support and advice.
Liaising and developing roles with housing department for patients who are homeless, including services available for patients who are discharged without accommodation which includes completing homeless applications and gathering relevant documentation. Following housing protocol so 72 hours’ notice is given prior to discharge.
Supporting home visits where there are concerns about the property and supporting ward OTs to complete OT assessments at home if needed.
Supporting with benefits (note this excludes PIP claims)
Support patients with assessment for council for housing
Supporting patients with access to food parcels and items required on discharge.
Linking with community support workers, to ensure continuity of care
Supporting patients attend rehab assessments
Support Repatriation to relevant area/countries and liaising with the home office for updates.
To support with opening and closing referrals on Rio for patients under the Flow and Discharge Team (Discharge pathway)
To develop strong working relationships and work in close partnership with ward multi-disciplinary teams, Patient Flow Hub, SF&DCs, Crisis teams, Community teams / services and social services to facilitate discharge from acute in-patient care to prevent delays and resolving complex discharge arrangements, for the effective, efficient and optimum management of inpatient beds.
To support the co-ordination of timely and appropriate assessment and safe discharge of people from acute inpatient beds.
Answer telephone calls in an efficient, courteous, professional and non-judgemental manner.
Act as a point of contact for incoming referrals especially out of office hours, and communication with all relevant personnel in the process.
Ensure all callers receive the correct response by following the Flow policy.
Effectively manage caller’s expectations whilst providing correct and accurate information at all times.
If there are no available beds within Oxleas, to advise the referrer of this and then begin the escalation process. The first point is to notify the SFDC so that they can make direct contact with the referrer to agree on a management plan.
To attend daily Flow handover calls and meetings, and update on any changes on the bed state
To form and maintain relationships with all oxleas teams, NHS teams and external services relevant to the discharge process.
Take account of the cultural issues in communication with everyone, including work colleagues
